Utilization Review Coordinator

4 weeks ago

Worcester, Massachusetts, United States Hospital for Behavioral Medicine Full time
About the Role

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 play a critical role in ensuring that our patients receive the best possible care.

Key Responsibilities
  • Conduct thorough reviews of patient treatment plans to ensure that they meet the necessary criteria for continued stay and discharge planning.
  • Communicate with external case managers and managed care organizations to obtain certification and recertification of insurance benefits.
  • Collaborate with the treatment team to understand the insurance company's requirements for continued stay and discharge planning.
  • Advocate for patients' access to services during treatment team meetings and through individual physician contact.
  • Chair treatment team meetings and continued stay reviews as indicated.
  • Review treatment plans and advocate for additional services as indicated.
  • Promote effective use of resources for patients.
  • 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.
Requirements
  • Bachelor's degree in nursing or Master's degree from an accredited college or university in social work, mental health, or related degree.
  • 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

We offer a competitive salary range of $62,400 - $93,600 annually, as well as a comprehensive benefits package, including 401(k) + matching, health insurance, and paid time off.

We are an equal opportunity employer and welcome applications from diverse candidates. Accommodations are available for applicants with disabilities.

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