Utilization Review Manager: Lead UM & Payer Excellence

Universal Hospital Services Inc.; Attleboro (MA); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Student loan repayment

Tuition reimbursement

401(K) with company match

SoFi student loan refinancing

Career development opportunities

Licensure supervision

Competitive compensation

Generous PTO

Benefits website

Job summary

Fuller Hospital in South Attleboro, MA is seeking a Manager of Utilization Review to lead utilization management, precertification, and discharge reviews. This 40-hour-per-week role focuses on regulatory compliance, payer engagement, and staff supervision within a behavioral health setting.

The ideal candidate holds MA licensure (RN/LCSW/LICSW/LMHC), with 3+ years in utilization review and leadership experience, and a proven ability to improve documentation, outcomes, and reimbursement.

Qualifications

• Licensure in MA as RN, LCSW, LICSW, or LMHC is required.
• 3+ years of Utilization Review experience preferred; supervisory experience preferred.

Responsibilities

• Oversees all utilization management functions.
• Oversees precertification, concurrent, and discharge reviews.
• Facilitates regulatory compliance through proper documentation and resource allocation.
• Acts as a key liaison with physicians to align engagement with payer expectations and discharge planning.
• Leads payer engagement activities including post-payment reviews and audits.
• Manages utilization management staff and performs administrative department head duties.

Skills

Utilization management

Regulatory compliance

Payer engagement

Leadership/management

Job description

Fuller Hospital in South Attleboro, MA is seeking a Manager of Utilization Review to lead utilization management, precertification, and discharge reviews. This 40-hour-per-week role focuses on regulatory compliance, payer engagement, and staff supervision within a behavioral health setting.

The ideal candidate holds MA licensure (RN/LCSW/LICSW/LMHC), with 3+ years in utilization review and leadership experience, and a proven ability to improve documentation, outcomes, and reimbursement.