Utilization Review Coordinator jobs in Worcester, MA

JOIN OUR TEAM AS A UTILIZATION REVIEW COORDINATOR!

Your Work Matters How will you make a difference?

The UR Coordinator is responsible for contacts external case managers/managed care organizations for certification and recertification of insurance benefits throughout the patient’s stay, and assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning. The UR Coordinator is responsible for having a thorough understanding of the patient’s treatment through communication with the treatment team. The UR Coordinator advocates for the patient’s access to services during treatment team meetings and through individual physician contact. The UR Coordinator chairs treatment team meetings and continued stay reviews as indicated.

Case Management/Utilization Management

• Review the treatment plan 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.
• Advocate that the patient is placed in the appropriate level of care and program.
• 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.

Treatment Planning

• Review assessment information.
• Attend and chair and coordinate treatment team continued stay reviews, as indicated.
• Communicate with attending physician and program managers, and other providers of service, to assure continuity of care, efficiency, and effective transitions between levels of care.
• Provide feedback to the attending physician and treatment team members concerning continuing certification of days/services.
• Communicate with external reviewers and referral sources. Conduct external reviews and maintain documentation of interactions.
• Ensure that third-party payers are notified of, or participate in, decisions about transitions between levels of care.

Discharge Planning

• Coordinate discharge plans with the patient/family/significant/other, when indicated.
• Ensure discharge appointments are made in keeping with insurance requirements.

Your Experience Matters What we’re looking for:

• Education & Licensure (if applicable):Bachelor’s degree in nursing or Master’s degree from an accredited college or university in social work, mental health or related degree required.
• Experience: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.

Your Care Matters What we provide for our team:

• 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

What sets us apart?

• Career & training development opportunities
• Dynamic and inclusive work environment
• Engaged management team dedicated to your success
• A guiding mission and set of values that serve as both our north star and yours, anchoring our collective purpose and aspirations

Disclaimer: Benefits are subject to change at the discretion of Hospital for Behavioral Medicine.

Compensation:

This is a full-timerole and the expected compensation range for this role is $62,400 - $93,600 annually. We’re eager to engage with all qualified candidates, and consideration will be provided to experience and skill level. Join us as our Utilization Review Coordinator!

Get to know us Outstanding Care, Compassionate People, Unparalleled Service

Discover a fulfilling career at Hospital for Behavioral Medicine (HBM)!

Welcome to the heart of mental health treatment innovation in Worcester, MA! HBM, a cutting-edge 120-bed inpatient facility, is the leading provider of exceptional therapeutic care, prioritizing patient comfort and safety. In proud collaboration with UMass Memorial Health Care, our facility is conveniently situated near the UMass Memorial Medical Center, allowing us to serve the community with unwavering dedication.

At HBM, we go beyond inpatient care by offering an outpatient partial hospitalization program, ensuring continuous support while respecting the rhythm of daily lives. Our commitment to accessible care knows no bounds, as we 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, and be a part of the transformative healthcare experience at Hospital for Behavioral Medicine.

To learn more about HBM, visit us at: https://www.hospitalforbehavioralmedicine.com/

TOGETHER WE CAN MAKE POSITIVE I.M.P.A.C.T.S.

Individuals Maintaining Positive Attitude and Commitment To Service