Behavioral Health Specialist
6 days ago
Job Overview
We are seeking a highly skilled Utilization Review Specialist to join our team at Westborough Behavioral Healthcare Hospital.
About the Role
The successful candidate will be responsible for monitoring adherence to the hospital's utilization review plan, ensuring effective and efficient use of hospital services. This includes monitoring appropriateness of hospital admissions and extended hospital stays, as well as completing data collection and analysis.
Key Responsibilities
- Initiate authorization requests and complete additional data collection as necessary.
- Perform concurrent reviews for patients to advocate for authorization of needed services.
- Advise treatment teams on documentation of medical necessity in patient records.
- Maintain communication with Social Services to facilitate timely discharge planning.
- Enter accurate documentation into systems describing patient-related activities.
- Ensure compliance with regulatory policies, privacy, and security standards.
Requirements
- Associate or Bachelor's degree in a Clinical or health-related field preferred or related experience.
- 2-3 years of experience as a UR Specialist, Medical Billing, or healthcare quality assurance.
- Knowledge of healthcare delivery systems and third-party reimbursement.
- Ability to interpret admission and continued stay criteria and understand medical terminology.
Salary and Benefits
Estimated salary: $60,000 - $80,000 per annum. Benefits include 401K, paid sick time, employee discount program, and employee assistance program.
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