Utilization Review Manager

UHS • $80K — $95K *
Attleboro, MA 02703In-Person
Healthcare
Less than 5 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Current Massachusetts licensure as a RN, LCSW, LICSW, or LMHC
  • 3+ years of experience in Utilization Review, supervisory experience preferred
  • Expert knowledge of insurance billing and procedures
  • Basic understanding of psychiatric and addictive disease diagnoses and treatment
  • Strong leadership and coaching abilities
  • Proficient in data analysis to identify trends
  • Familiarity with managed care practices and behavioral health operations

Responsibilities

  • Oversee all utilization management functions
  • Manage precertification, concurrent, and discharge reviews
  • Ensure regulatory compliance through proper documentation
  • Act as a key member of the hospital management team
  • Liaise with hospital physicians to align payer expectations with clinical needs
  • Lead payer engagement activities including audits and appeals oversight
  • Manage utilization management staff and departmental functions

Benefits

  • $200/month Student Loan Repayment
  • $5,000/year Tuition Reimbursement
  • Challenging and rewarding work environment
  • 26 days of Paid Time Off (PTO) annually, plus rollover
  • Comprehensive Medical, Dental, Vision, and Prescription Drug Plans
  • 401(K) with company match
  • SoFi Student Loan Refinancing Program
  • Career development opportunities across 300+ subsidiaries
  • Supervision for Licensure
Full Job Description
Responsibilities

Manager of Utilization Review Opportunity -

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.

The Manager of Utilization oversees utilization management including, but not limited to: utilization review, case documentation, payer relationships, regulatory requirements, staff management and department administration. Supports the overall success of the hospital and promotes patient satisfaction, regulatory compliance and optimal reimbursement. This is a full time, 40 hour per week position.

Responsibilities
  • Oversees all utilization management functions
  • Oversees precertification, concurrent, and discharge utilization reviews
  • Facilitates regulatory compliance by ensuring proper documentation and allocation of treatment resources
  • Serves as a key member of the hospital management team. Acts as a key participant in hospital operations meetings that drive financial and clinical results
  • Functions as a key liaison with all hospital physicians to align physician engagement with payer expectations, patient acuity and discharge planning requirements
  • Leads payer engagement activities including post payment reviews, payer audit oversight and denial/appeal oversight
  • Manages utilization management staff and performs all administrative department head functions
  • Performs other duties as assigned/required by this position
Benefit Highlights
  • Student Loan Repayment - $200 per month
  • Tuition Reimbursement - $5,000 per year
  • Challenging and rewarding work environment
  • Competitive Compensation & Generous Paid Time Off (26 days per year + roll over)
  • Excellent Medical, Dental, Vision and Prescription Drug Plans
  • 401(K) with company match and discounted stock plan
  • SoFi Student Loan Refinancing Program
  • Career development opportunities within UHS and its 300+ Subsidiaries!
  • Supervision for Licensure
  • More information is available on our Benefits Guest Website: benefits.uhsguest.com


Qualifications

Requirements
  • Licensure: Current Massachusetts licensure as a RN, LCSW, LICSW, or LMHC
  • Experience: Three (3) or more years of experience in Utilization Review strongly preferred - At least one (1) year of direct supervisory experience preferred.
  • Knowledge/Skills:
  • Moderate to Expert knowledge of Insurance procedures and terminology as well as Billing procedures and terminology
  • Basic knowledge of psychiatric and addictive disease diagnosis and treatment. Knowledge of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnostic codes with corresponding clinical assessment skills that support patient evaluation
  • Leadership skills and ability to provide feedback and coaching to employees
  • Ability to problem-solve and exercise sound time management
  • Experience using data to identify trends. Ability to manage team productivity and compliance with required timelines
  • Knowledge of managed care payer business practices, behavioral health hospital operations and medical necessity determinations

About UHS

UHS Careers

Joining UHS presents an unparalleled opportunity to become part of a leading team of healthcare professionals dedicated to making a difference. UHS, known for its commitment to innovation and leadership in the healthcare sector, offers a variety of job opportunities that cater to a diverse range of skills and experiences.

Explore Job Opportunities

UHS is actively hiring and offers a wide array of positions, from clinical roles to administrative support. Each position at UHS is designed to challenge team members while providing meaningful service to the community. Explore the current job openings and find a career path that suits professional aspirations and skills.

Internship Programs

UHS provides robust internship programs that offer hands-on experience in the healthcare industry. Internships are a cornerstone of professional development, giving participants a chance to deepen practical skills in a real-world setting. These programs are tailored to foster growth and prepare interns for a full-time position within the company.

Professional Growth and Development

UHS believes in nurturing the career growth of its team members through comprehensive professional development programs. These include leadership training, diversity training, and continuous education in the latest healthcare practices, ensuring that every team member has the opportunity to advance their career.

Benefits and Culture

Employment at UHS comes with competitive benefits designed to support the health, well-being, and financial security of each team member and their families. The company culture at UHS is built on a foundation of respect and inclusion, where diversity is celebrated and every voice is heard.

Networking and Innovation

UHS encourages a culture of innovation where team members are motivated to bring forward ideas that drive improvement and efficiency. Networking within the company is supported through various events and internal platforms, helping team members to connect, share insights, and collaborate on projects.

Applying for a Position

To apply for a position at UHS, candidates should prepare their resume to highlight relevant experience and skills. The interview process at UHS is thorough, aiming to assess not only the professional qualifications but also the alignment with the company’s values and culture. Interested candidates can visit the UHS Careers page to submit an application and learn more about the hiring process.

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Industry
Hospitals & Medical Centers
* Ladders Estimates

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