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Westborough Behavioral Healthcare Hospital provided pay range This range is provided by Westborough Behavioral Healthcare Hospital. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range $52,000.00/yr - $72,800.00/yr
Who Are We: Westborough Behavioral Healthcare Hospital (WBHH) provides psychiatric stabilization and dual diagnosis treatments for Children, Adolescents and Adult populations in both inpatient and outpatient settings. Our goal is to ensure patients and their loved ones feel comfortable and are well informed regarding treatment options.
We are conveniently located in Westborough near the intersection of Route 495 and Route 9. The hospital operates 24/7 with multiple shifts available.
Westborough Behavioral Healthcare Hospital is looking for a UR Specialist to provide Per Diem coverage.
Job Description: The Utilization Review Specialist is responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services. Monitors the appropriateness of hospital admissions and extended hospital stays. Completing data collection of demographic, claim and medical information; non‑medical analysis; and outcomes reporting.
Essential Duties: Initiates authorization requests and ensures they are complete or requests additional data as necessary
Performs concurrent reviews for patients to advocate for authorization for services needed
Advises treatment team in documentation of medical necessity in the medical record
Maintains communication with the Social Services department to facilitate timely discharge planning
Enters complete and accurate documentation into the system describing all patient related admitting/registration activities
Follows all regulatory policies and procedures, privacy and security standards in accordance with government agencies including HIPAA requirements
Submits discharge clinical as required by payers
Upholds the Organization's ethics and customer service standards
Requirements: Associate or Bachelor degree in a clinical (medical) or health related field is preferred or related experience
2-3 years experience working as a UR Specialist, Medical Billing or health care quality assurance
3 years of experience in psychiatric setting preferred
Knowledge of health care service delivery systems, and third party reimbursement; knowledge of managed care environment
Ability to apply and interpret admission and continued stay criteria; understanding of admission and discharge function; familiarity with medical terminology, diagnostic terms and treatment modalities; knowledge of medical record keeping