Utilization Review Specialist

4 weeks ago

Worcester, Massachusetts, United States Hospital for Behavioral Medicine Full time
Job Title: Utilization Review Coordinator

Hospital 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 treatment plans and advocate for additional services as needed to ensure patients receive the best possible care.
  • Promote effective use of resources for patients, ensuring that they receive the necessary services and support to achieve their goals.
  • Ensure patient rights are upheld, and their needs are met in a timely and efficient manner.
  • Maintain ongoing contact with the attending physician, program manager, nurse manager, and treatment team to ensure seamless communication and coordination.
  • Collaborate with the treatment team regarding continued stay and discharge planning issues to ensure a smooth transition for patients.
  • Advocate for patients to be placed in the appropriate level of care and program, ensuring that their needs are met and they receive the best possible care.
  • Interface with program staff to facilitate a smooth transition at the time of transfer or discharge, ensuring that patients receive the necessary support and services.
  • Maintain documentation related to case management activities, ensuring that all necessary information is accurately recorded and up-to-date.
  • Assure timely completion of insurance reviews, ensuring that patients receive the necessary services and support in a timely manner.
  • Maintain statistical reports and prepare documentation of significant findings, providing valuable insights to inform decision-making and improve patient outcomes.
  • Communicate insurance requirements to all levels of staff, ensuring that everyone is aware of the necessary procedures and protocols.
  • Provide timely updates regarding patient status, ensuring that all stakeholders are informed and up-to-date.
Treatment Planning:
  • Review assessment information to ensure that patients receive the necessary services and support.
  • Attend and chair treatment team continued stay reviews, ensuring that patients receive the best possible care.
  • Communicate with attending physician and program managers to ensure continuity of care and ensure that patients receive the necessary services and support.
  • Provide feedback to the attending physician and treatment team members regarding continuing certification of days/services, ensuring that patients receive the best possible care.
  • Communicate with external reviewers and referral sources, ensuring that patients receive the necessary services and support.
Discharge Planning:
  • Coordinate discharge plans with patients and their families, ensuring that they receive the necessary support and services.
  • Ensure discharge appointments are made in accordance with insurance requirements, ensuring that patients receive the necessary services and support.
Requirements:
  • Bachelor's degree in nursing or Master's degree in social work, mental health, or related field.
  • Minimum of two years of experience in a behavioral healthcare setting or managed care company.
What We Offer:
  • Competitive salary range: $62,400 - $93,600 annually.
  • 401(k) + matching.
  • Health insurance.
  • 100% company-paid life insurance coverage.
  • 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.

We value a diverse, inclusive workforce and provide equal employment opportunities for all applicants and employees. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity or expression, age, marital status, veteran status, disability status, pregnancy, parental status, genetic information, political affiliation, or any other status protected by the laws or regulations in the locations where we operate.

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