Utilization Review Coordinator

Southcoast Health System Fairhaven , MA 02719

Posted 11 months ago

At Southcoast Health, we acknowledge that our employees are what helps make us great!# # We are searching for a Utilization Review Coordinator who, under the direction of the Director, Business Operations and IT or designee, will perform a variety of duties including but not limited to: working with clinical staff to support appropriate utilization of Home Care services, conducting comprehensive and ongoing review of clinical information against approved criteria for the purpose of certifying referred services, level of care, and duration of treatment as medically necessary for positive healthcare outcomes, performing prospective review of Medicare oasis assessments, ensuring all services and documentation meet the organizations standards and state and federal guidelines and acting as a utilization review resource and mentor to colleagues.# May provide functional or technical supervision over the employees in same or closely related classification, where the scope of supervisory responsibility is limited to occasional direction, guidance, explanation, training, etc. Hours: 40hrs (full time) Shift:

Day Shift # Education and/or Experience

Requirements:
Equal to completion of four years of high school plus additional specialized courses or training. Two to three years of homecare experience preferred.

HCS-D # COS-C certification required.

Experience in clinical environment preferred. Case review experience and knowledge of relevant regulatory and compliance guidelines required.

Experience with patient billing preferred.

Must possess and demonstrate excellent time management and organizational skills with ability to work independently to meet deadlines and productivity goals. Must possess and demonstrate ability to focus on detail and perform work accurately.

Knowledge of medical terminology required. Working knowledge of Microsoft Word, Excel, PowerPoint and Outlook is required.

Experience with an EMR system preferred.

Must possess and demonstrate highly effective interpersonal, customer service and communication skills. Southcoast Health is a community based health delivery system with multiple access points, offering an integrated continuum of health services throughout Southeastern Massachusetts and East Bay, Rhode Island. For more than 100 years, we have provided quality, patient-focused care in a stet-of-the-art environment.

By uniting a single purpose and building an integrated system of services and resources, we have become one of the largest and fastest-growing health systems in Massachusetts. # Together We Are More. 311 years of hospitals# collective continuous services 920 + square miles of service across southern MA + East bay, RI 7400 + employees doctors, nurses, professionals in IT, Finance, HR, and more Top 5% of USA hospitals for 2017 clinical performance by Healthgrades # We are committed to providing our employees in MA and RI with optimal benefits that promote a healthy work/life balance and add value to our employees# lives. Generous Earned Time Off Package Health, Dental #and Vision Insurance
  • Tuition Assistance Short Term and Long Term Disability Insurance

  • Life # AD#D insurance

  • Flexible Spending Accounts* 403B Retirement Plan with match HealthQuest Wellness Program Employee Assistance Program Employee Discount Program Career Development Opportunities *Available to regular status employees who are scheduled to work a minimum of 24 hours.# Available to regular status employees who are scheduled to work a minimum of 20 hours. # Are you ready to make a difference in your community? Join us in our strive to be more than medicine!#

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Utilization Review Coordinator

Southcoast Health System