Utilization Review Coordinator - Remote

Overview

The Utilization Review Coordinator at UMass Memorial Health is responsible for ensuring optimal clinical and financial outcomes for patients by coordinating resources, collaborating with treatment teams, and managing third-party payer communications.

In Short

• Coordinate resources for patient outcomes.
• Collect and analyze data related to care processes.
• Collaborate with physicians and treatment teams.
• Communicate with third-party payers regarding patient care.
• Assist in discharge planning and aftercare appointments.
• Review charts for resource utilization.
• Maintain utilization review worksheets.
• Recommend treatment interventions.
• Ensure compliance with departmental policies.
• Participate in meetings and quality improvement initiatives.

Requirements

• Master’s degree in psychology, counseling, or Human Services.
• 3-5 years of direct clinical experience.
• Excellent negotiation and communication skills.
• Prior knowledge of psych medications is helpful.
• Assertive problem-solving skills.
• Experience with Meditec is required.
• Case management experience is preferred.
• Proficiency in Word and Excel is preferred.
• Familiarity with DSM4R coding is preferred.

Benefits

• Signing bonus eligibility.
• Comprehensive benefits package.
• Opportunities for professional growth.
• Supportive work environment.
• Commitment to diversity and inclusion.
• Employee wellness programs.
• Flexible working hours.
• Collaborative team culture.
• Access to ongoing training and education.
• Participation in quality improvement initiatives.