Job description

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. Pembroke Hospital asks all employees to use their best judgment in every circumstance. We have great confidence in your ability to make the right decision as it relates to our Patients, the Hospital and your Career

We are currently seeking Per Diem Utilization Review Coordinator(s) 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.

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.

Requirements: RN, LICSW, LMHC with current license in the State of Massachusetts. Experience in Utilization Management either with a provider, insurance or HMO organization. Experience in a behavioral health setting is preferred.

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.

Job Type: Part-time

Schedule:

• Day shift
• Monday to Friday

Experience:

• Utilization Review: 1 year (Required)

License:

• RN, LICSW, LMHC (Required)

Hours per week:

• Less than 10

Patient Type:

• Adults
• Geriatric

Typical start time:

• 8AM

Typical end time:

• 4PM

This Job Is:

• A job for which all ages, including older job seekers, are encouraged to apply

Company's website:

• www.pembrokehospital.org

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