Utilization Review Coordinator

2 weeks ago

Worcester, Massachusetts, United States Hospital for Behavioral Medicine Full time
Job Summary

We are seeking a highly skilled Utilization Review Coordinator to join our team at Hospital for Behavioral Medicine. As a key member of our healthcare team, you will be responsible for ensuring that patients receive the necessary care and services to achieve optimal health outcomes.

Key Responsibilities
  • Conduct thorough reviews of patient treatment plans to ensure that they are aligned with insurance company requirements.
  • Communicate with external case managers and managed care organizations to obtain certification and recertification of insurance benefits.
  • Collaborate with the treatment team to understand insurance company requirements and advocate for patients' access to services.
  • Chair treatment team meetings and continued stay reviews as indicated.
  • Review treatment plans and advocate for additional services as needed.
  • Promote effective use of resources for patients and ensure that patient rights are upheld.
  • Maintain ongoing contact with the attending physician, program manager, nurse manager, and various members of the team.
  • Collaborate with the treatment team regarding continued stay and discharge planning issues.
  • Interface with program staff to facilitate a smooth transition at the time of transfer or discharge.
  • Maintain documentation related to case management activities.
  • Assure tracking of insurance reviews and that reviews are completed in a timely manner.
  • Maintain statistical reports and prepare documentation of significant findings.
  • Communicate insurance requirements to all levels of staff.
  • Provide timely updates regarding patient status on log sheets that are prepared for daily meetings concerning admissions, reviews, and discharges.
  • Update the denial log statistics on an ongoing basis (at least weekly), and initiate appeals through telephone or written communication within 7 to 10 days of denial.
  • Consult with the business office and/or admission staff as needed to clarify data and ensure the insurance precertification process is complete.
  • Provide clinical information to managed care companies, insurance companies, and other third-party reviewers to establish the length of stay or number of certified days.
  • Coordinate with the insurance company doctor in appeals process and denials process.
Requirements
  • Bachelor's degree in nursing or Master's degree from an accredited college or university in social work, mental health, or related degree required.
  • A minimum of two (2) years experience in a behavioral healthcare setting or managed care company, with experience in patient assessment, treatment planning, utilization management, and/or case management.
What We Offer
  • 401(k) + matching
  • Health insurance 100% company-paid life insurance coverage up to 2x your annual salary
  • Vision insurance
  • Dental insurance
  • 100% company-paid long-term disability insurance
  • Paid time off
  • Paid holidays
  • Cafeteria on site + discounted meals
  • Employee engagement events
  • Employee assistance program
  • Employee recognition program
  • Free parking
About Us

Hospital for Behavioral Medicine is a leading provider of exceptional therapeutic care, prioritizing patient comfort and safety. We are committed to accessible care and emphasize availability irrespective of one's ability to pay. Join us in providing exceptional care and contributing to the well-being of individuals and families in need.

  • Utilization Review Coordinator

    3 weeks ago

    Worcester, Massachusetts, United States Hospital for Behavioral Medicine Full time

    About the RoleWe are seeking a highly skilled and compassionate Utilization Review Coordinator to join our team at Hospital for Behavioral Medicine. As a key member of our healthcare team, you will play a vital role in ensuring that our patients receive the necessary care and services to achieve optimal health outcomes.Key ResponsibilitiesConduct thorough...

  • Utilization Review Coordinator

    4 weeks ago

    Worcester, Massachusetts, United States Hospital for Behavioral Medicine Full time

    About the RoleWe are seeking a highly skilled Utilization Review Coordinator to join our team at Hospital for Behavioral Medicine. As a key member of our healthcare team, you will play a critical role in ensuring that our patients receive the best possible care.Key ResponsibilitiesConduct thorough reviews of patient treatment plans to ensure that they meet...

  • Utilization Review Specialist

    4 weeks ago

    Worcester, Massachusetts, United States Hospital for Behavioral Medicine Full time

    Job Title: Utilization Review CoordinatorHospital for Behavioral Medicine is seeking a highly skilled professional to fill the role of Utilization Review Coordinator. As a key member of our team, you will play a critical role in ensuring that patients receive the necessary services and resources to achieve optimal outcomes.Key Responsibilities:Review...

  • Behavioral Health Utilization Review Specialist

    5 days ago

    Worcester, Massachusetts, United States Hospital for Behavioral Medicine Full time

    About the RoleWe are seeking a highly skilled Utilization Review Coordinator to join our team at Hospital for Behavioral Medicine. As a key member of our clinical team, you will play a critical role in ensuring that our patients receive the highest level of care and support.Key ResponsibilitiesConduct thorough reviews of patient treatment plans to ensure...

  • Chart Review Specialist

    4 weeks ago

    Worcester, Massachusetts, United States Fallon Health Full time

    About Fallon HealthFallon Health is a company that prioritizes its members' needs, ensuring they receive the care they deserve. Founded in 1977 in Worcester, Massachusetts, we deliver equitable, high-quality, coordinated care and are consistently rated among the nation's top health plans for member experience, service, and clinical quality.Job SummaryWe are...

  • Logistics Coordinator

    2 days ago

    Worcester, Massachusetts, United States Dennison Lubricants, Inc. Full time

    Job SummaryDennison Lubricants, Inc. is seeking a skilled Logistics Coordinator to join our team. As a key member of our delivery operations, you will be responsible for ensuring the safe and efficient transportation of bulk products to our customers.Key ResponsibilitiesReview daily delivery documents to ensure accuracy and completenessConfirm delivery...

  • Care Coordinator RN

    1 month ago

    Worcester, Massachusetts, United States U Mass Memorial Health Full time

    Job SummaryWe are seeking a highly skilled Registered Nurse to join our Care Coordination team at UMass Memorial Health. As a Care Coordinator RN, you will play a critical role in ensuring the seamless transition of patients from hospital to home, while also promoting high-quality patient care and outcomes.Key ResponsibilitiesConduct thorough assessments of...

  • Intake Coordinator

    4 days ago

    Worcester, Massachusetts, United States Hospital for Behavioral Medicine Full time

    About the RoleWe are seeking a highly skilled and compassionate Intake Technician to join our team at Hospital for Behavioral Medicine. As a key member of our admissions team, you will play a critical role in ensuring a smooth and efficient intake process for our patients.Key ResponsibilitiesAssist in the process of receiving and scheduling inquiry calls,...

  • Gas Utility Lead Laborer

    4 weeks ago

    Worcester, Massachusetts, United States Centuri Group, Inc. Full time

    Job SummaryWe are seeking a skilled Lead Laborer to join our team at Centuri Group, Inc. in Worcester, MA. As a Lead Laborer, you will be responsible for performing general labor work, including excavating, trenching, and shoring, while working around heavy equipment. You will also assist in planning, coordinating, and supervising all crew personnel on daily...

  • Stroke Coordinator

    3 days ago

    Worcester, Massachusetts, United States Tenet Massachusetts Full time

    Job Title: Stroke CoordinatorTenet Massachusetts is seeking a highly skilled Stroke Coordinator to join our team in Worcester, Massachusetts.Job Summary:The Stroke Coordinator will be responsible for facilitating and coordinating the Key Elements of the Stroke Certification process, including development and review of protocols, initial and ongoing training,...

  • Stroke Coordinator

    1 month ago

    Worcester, Massachusetts, United States Tenet Massachusetts Full time

    Job Title: Stroke CoordinatorJoin Tenet Massachusetts as a Stroke Coordinator and be part of a team dedicated to delivering high-quality healthcare to our community.About the Role:We are seeking a highly skilled and experienced Stroke Coordinator to join our team at Saint Vincent Hospital in Worcester, Massachusetts. As a Stroke Coordinator, you will play a...

  • Stroke Coordinator

    4 weeks ago

    Worcester, Massachusetts, United States Tenet Massachusetts Full time

    Job Title: Registered Nurse - Stroke CoordinatorTenet Massachusetts is seeking a highly skilled Registered Nurse to join our team as a Stroke Coordinator. This is a full-time position at Saint Vincent Hospital in Worcester, Massachusetts.Job Summary:The Stroke Coordinator will be responsible for facilitating and coordinating the Key Elements of the Stroke...

  • Stroke Coordinator

    4 days ago

    Worcester, Massachusetts, United States Tenet Massachusetts Full time

    Job Title: Stroke CoordinatorTenet Massachusetts is seeking a highly skilled Stroke Coordinator to join our team at Saint Vincent Hospital in Worcester, Massachusetts.About the Role:The Stroke Coordinator will play a critical role in facilitating and coordinating the Key Elements of the Stroke Certification process, including development and review of...

  • Project Coordinator

    5 days ago

    Worcester, Massachusetts, United States Abstrakt Marketing Group Full time

    Job Title: Junior/Assistant Project ManagerWe are seeking a highly motivated and organized Junior/Assistant Project Manager to join our team at Abstrakt Marketing Group. As a key member of our construction management team, you will be responsible for supporting the project manager in the coordination of project team meetings, preparing project management...

  • Stroke Coordinator

    4 weeks ago

    Worcester, Massachusetts, United States Tenet Massachusetts Full time

    Job Title: Stroke CoordinatorTenet Massachusetts is seeking a highly skilled Stroke Coordinator to join our team at Saint Vincent Hospital in Worcester, Massachusetts.About the Role:The Stroke Coordinator will play a critical role in facilitating and coordinating the Key Elements of the Stroke Certification process, including development and review of...

  • Stroke Coordinator

    1 month ago

    Worcester, Massachusetts, United States Tenet Massachusetts Full time

    About the RoleTenet Massachusetts is seeking a highly skilled Registered Nurse to fill the position of Stroke Coordinator. This role will be responsible for facilitating and coordinating the Key Elements of the Stroke Certification process, including development and review of protocols, initial and ongoing training, performance improvement and community...

  • Stroke Coordinator RN

    22 hours ago

    Worcester, Massachusetts, United States Inova Health System Full time

    Job SummaryWe are seeking a highly skilled Stroke Coordinator RN to join our team at Inova Health System. As a Stroke Coordinator RN, you will play a critical role in facilitating and coordinating the Key Elements of the Stroke Certification process, including development and review of protocols, initial and ongoing training, performance improvement, and...

  • Stroke Coordinator RN

    4 weeks ago

    Worcester, Massachusetts, United States Tenet Massachusetts Full time

    Job Title: Registered Nurse Stroke CoordinatorCompany: Tenet Massachusetts FacilitiesWe are seeking a highly skilled and experienced Registered Nurse to join our team as a Stroke Coordinator. As a key member of our healthcare team, you will play a vital role in ensuring the highest quality of care for our patients.Job Summary:The Registered Nurse Stroke...

  • Stroke Coordinator RN

    4 weeks ago

    Worcester, Massachusetts, United States Tenet Massachusetts Full time

    Job Title: Stroke Coordinator RNTenet Massachusetts is seeking a highly skilled and experienced Registered Nurse to fill the role of Stroke Coordinator RN. This is a full-time position that requires a strong background in neuroscience patient care and a passion for delivering high-quality patient outcomes.Job Summary:The Stroke Coordinator RN will be...

  • Stroke Coordinator RN

    2 weeks ago

    Worcester, Massachusetts, United States Tenet Massachusetts Full time

    Job Title: Stroke Coordinator RNTenet Massachusetts is seeking a highly skilled and experienced Stroke Coordinator RN to join our team at Saint Vincent Hospital in Worcester, Massachusetts.About the Role:The Stroke Coordinator RN will be responsible for facilitating and coordinating the Key Elements of the Stroke Certification process, including development...