Utilization Review Specialist - Behavioral Health

Universal Hospital Services Inc.; Pembroke (MA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Competitive pay

Generous PTO

Medical coverage

401(k) match

Student loan refinancing

Tuition discount

Tuition reimbursement

Loan repayment

Job summary

Pembroke Hospital is seeking a dedicated Utilization Review Coordinator to join our 120-bed acute care facility south of Boston. This full-time position supports clinical reviews, payer authorization, and documentation to ensure appropriate utilization and optimal reimbursement.

You will collaborate with the multidisciplinary team and coordinate with social services, business office, and Nursing to align patient documentation with payer criteria and CMS guidelines.

Qualifications

• Requires Massachusetts licensure as RN/LCSW/LICSW/LMHC.
• Experience in Utilization Management.
• Behavioral health experience preferred.

Responsibilities

• Performs daily utilization reviews with payer types to secure authorization.
• Educates and guides on level of care and payer expectations for patient acuity.
• Completes appeal/denial letters and supports audits.
• Collaborates with hospital operations to align documentation with patient conditions.
• Contributes to monthly utilization data trends for overall operation.
• Facilitates physician reviews with payers as required.
• Performs other duties as assigned.

Skills

Utilization Review

Payer coordination

Multidisciplinary teamwork

Education

Massachusetts licensure (RN/LCSW/LICSW/LMHC)

Job description

Pembroke Hospital is seeking a dedicated Utilization Review Coordinator to join our 120-bed acute care facility south of Boston. This full-time position supports clinical reviews, payer authorization, and documentation to ensure appropriate utilization and optimal reimbursement.

You will collaborate with the multidisciplinary team and coordinate with social services, business office, and Nursing to align patient documentation with payer criteria and CMS guidelines.