Utilization Review Manager — Lead Compliance & Payer Relations

Universal Hospital Services Inc.; South Attleboro (MA); On-site; USD 90,000 - 130,000; Full time

Benefits offered by this job

Student Loan Repayment

Tuition Reimbursement

26 days PTO + rollover

Health/Dental/Vision

Job summary

Fuller Hospital in South Attleboro, MA is seeking a Manager of Utilization Review to oversee utilization management, documentation, payer relationships and regulatory compliance. This is a full-time, 40-hour-per-week role within a private behavioral health facility serving MA and RI residents.

The position requires MA licensure (RN/LCSW/LICSW/LMHC), 3+ years in Utilization Review and at least 1 year in supervision.

Qualifications

• Current Massachusetts licensure as RN, LCSW, LICSW, or LMHC.
• 3+ years of Utilization Review experience.
• At least 1 year of direct supervisory experience.

Responsibilities

• Oversee all utilization management functions.
• Oversee precertification, concurrent, and discharge reviews.
• Ensure regulatory compliance through proper documentation and resource allocation.
• Act as a key member of hospital management and drive financial and clinical results.
• Liaise with hospital physicians to align engagement with payer expectations and discharge planning.
• Lead payer engagement activities including post payment reviews and audits.
• Manage utilization management staff and perform administrative duties.
• Perform other duties as assigned.

Skills

Utilization Review

Supervisory experience

Payer relations

Regulatory compliance

Data analysis

Education

RN/LCSW/LICSW/LMHC licensure

Tools

None

Job description

Fuller Hospital in South Attleboro, MA is seeking a Manager of Utilization Review to oversee utilization management, documentation, payer relationships and regulatory compliance. This is a full-time, 40-hour-per-week role within a private behavioral health facility serving MA and RI residents.

The position requires MA licensure (RN/LCSW/LICSW/LMHC), 3+ years in Utilization Review and at least 1 year in supervision.