Job Description

Responsibilities

Pembroke Hospital is a -bed acute care, inpatient behavioral health facility located south of Boston, in Pembroke, MA. Situated on acres, we offer inpatient and partial hospitalization treatment to teens, adults and older adults, and our services are designed to assess, stabilize, and treat patients by addressing their primary symptoms and problems.

At Pembroke Hospital, all positions begin and end with caring for the Patient . By Listening Deeply and Understanding the Story of our Patients, we will Make a Difference in the Lives we Touch.

We are currently seeking a Part Time, hour per week, Utilization Review Coordinator to function as a primary liaison between all third party payors and the hospital.

This job is responsible for communicating required clinical information for the purpose of obtaining certification and approval for payment in the inpatient and partial levels of hospitalization.

The Utilization Review Coordinator works collaboratively with all payers as well as the behavioral health team, attending physicians, case managers, nurses, business office, etc.

to ensure authorization is received for the services provided.

Benefit Highlights :

• Challenging and rewarding work environment
• Competitive Compensation
• Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plan

K) with generous company match and discounted stock plan

• Career development opportunities within UHS and its Subsidiaries
• Tuition Reimbursement
• Further your education at a low cost through our Tuition Discount partnership with Chamberlin University

Responsibilities

• Serves as the primary contact for all payors regarding utilization review and management issues.
• Performs concurrent payor reviews for patients in an inpatient / partial setting according the payor guidelines, rules and regulations.
• Collaborates with Unit Treatment Team regarding a patient’s care while hospitalized.
• Provides all required clinical information to the payor according to the payors timeframe standards throughout the hospitalization to obtain certification approval.
• Maintains a collaborative working relationship with the payors, case managers and maintains contact with the payor regarding initial assessment, progress, changes in condition, discharge planning, discharge date, etc. as needed.
• Notifies all cases that are denied by the payor to the Director of Utilization Review. Initiate and coordinates the payor appeal process for all concurrent denials including notifying the attending physician so he / she can schedule a time to discuss the denied case.

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc.

UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune corporation, annual revenues were over $ billion in 0.

In 1, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of U.

S.’ Largest Public Companies. Headquartered in King of Prussia, PA, UHS has over , employees and continues to grow through its subsidiaries.

Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.

S. states, Washington, D.C., Puerto Rico and the United Kingdom.

Qualifications

Requirements

• RN, LICSW, LMHC with current license in the State of Massachusetts.
• Experience in Utilization Management either with a provider, insurance or HMO organization.

Last updated : 2024-06-06