Clinical Utilization Specialist
2 days ago
Cooley Dickinson Health Care, a member of the Mass General Brigham system, is a leading healthcare provider in western Massachusetts. With a rich history dating back to 1886, we have been advancing healthcare in our community for over a century.
Our network of medical professionals and support staff is dedicated to delivering high-quality care to our patients. With locations in Northampton and twelve surrounding towns, we provide comprehensive services to meet the diverse needs of our community.
Our MissionWe are committed to providing exceptional patient care, advancing medical knowledge, and promoting health and wellness in our community.
Job SummaryThe Utilization Review Specialist is a key member of our healthcare team, responsible for ensuring that patients receive the most appropriate level of care. This role requires a strong understanding of clinical best practices and the ability to communicate effectively with patients, families, and healthcare providers.
Responsibilities- Conduct concurrent reviews with insurance payers to determine patient level of care
- Use clinical best practice knowledge to ensure quality outcomes and appropriate reimbursement
- Collaborate with healthcare providers to develop effective care plans
- Communicate with patients and families to ensure understanding of care plans and services
- Graduate of an approved, accredited school of nursing
- RN licensure in the Commonwealth of Massachusetts
- Case Management certification preferred
- One to three years experience in hospital or payer-based case management, discharge planning, utilization management, and/or reimbursement
Cooley Dickinson Health Care offers a dynamic and supportive work environment, with opportunities for professional growth and development. We are committed to providing our employees with the resources and support they need to succeed in their roles.
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