Utilization Review Coordinator
UHS
Summary
Fuller Hospital is a 109-bed licensed, private psychiatric facility located in South Attleboro, Massachusetts providing inpatient and outpatient behavioral health services to residents of Massachusetts and Rhode Island. Inpatient units are designed to treat adults with general psychiatric or intellectual disabilities, as well as adolescents with general psychiatric issues. Patients with co-occurring psychiatric and substance abuse disorders can be treated on most units. Fuller Hospital also provides a less intensive Partial Hospitalization Program (PHP) to patients with psychiatric and co-occurring psychiatric and substance abuse disorders.
Job description
The Utilization Review Coordinator is responsible for monitoring the effective and efficient use of health care resources by review of patient admission and continued stay appropriateness in all programs of the hospital. They interact with outside agencies, third party payers, and managed care companies in accordance with contractual agreements, acting as a patient advocate and a representative of the hospital. This is a full time, 40 hour per week position.
Responsibilities
- Thoroughly reviews the patient’s medical record, assesses the medical necessity for all admissions based on DSM-IV and hospital criteria
- Reviews the patient’s treatment through the course of hospitalization to ensure appropriateness of care
- Documents criteria and reviews findings according to established policy, procedure, and protocols
- Performs other duties as assigned/required by this position
Qualifications
- Licensure: Current Massachusetts licensure as a RN, LCSW, LICSW, or LMHC
- Experience: One (1) or more years of experience in utilization management, insurance, and/or HMO organization
- Knowledge: Must be able to demonstrate knowledge and skills necessary to provide interventions appropriate to the age of the patients with whom they interact; Demonstrate knowledge of the principles of growth and development over the lifespan, possess the ability to assess data reflective of the patient’s status, and interpret the appropriate information needed to identify each patient’s requirements relative to their age specific needs.
Requirements
- Current Massachusetts licensure as a RN, LCSW, LICSW, or LMHC
- One (1) or more years of experience in utilization management, insurance, and/or HMO organization
- Must be able to demonstrate knowledge and skills necessary to provide interventions appropriate to the age of the patients with whom they interact
- Demonstrate knowledge of the principles of growth and development over the lifespan
- Possess the ability to assess data reflective of the patient’s status
- Interpret the appropriate information needed to identify each patient’s requirements relative to their age specific needs
Benefits
- Student Loan Repayment
- Tuition Reimbursement
- Paid Time Off
- Medical, Dental & Vision
- Prescription Drug Plans
- 401(k) Matching
- Discounted Stock Plan
- SoFi Student Loan Refinancing
- Career Development
- Supervision for Licensure
Company overview
Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected providers of hospital and healthcare services, operating as a Fortune 300 corporation headquartered in King of Prussia, Pennsylvania. Founded in 1979, UHS has grown into a major healthcare enterprise with approximately 99,000 employees and annual revenues exceeding $14 billion. The company operates through its subsidiaries, managing 29 acute care hospitals, 331 behavioral health facilities, and 60 outpatient and other facilities across 39 U.S. states, Washington D.C., Puerto Rico, and the United Kingdom. UHS provides comprehensive healthcare services including acute care, behavioral health treatment, cancer centers, and ambulatory surgical centers. The company's strategy focuses on building or acquiring high-quality hospitals in rapidly growing markets and investing in advanced medical equipment and skilled personnel to become the leading healthcare provider in each community it serves. UHS is publicly traded on the New York Stock Exchange (NYSE: UHS) and has established a strong reputation for delivering compassionate, high-quality care while maintaining financial stability and operational excellence.