Utilization Reviewer 40 hrs days Psych Administration
Company: Tenet Healthcare Corporation
Posted on: June 12, 2021
MetroWest Medical Center is the largest community health care
system between Worcester and Boston. MetroWest Medical Center is
committed to providing high quality, comprehensive care, at a
location close to home. The 307-bed regional healthcare system
includes Framingham Union Hospital, Leonard Morse Hospital in
Natick and the MetroWest Wellness Center. MetroWest Medical Center
has been named to the 2019 America's 100 Best Hospitals List by
The Utilization Reviewer will work with both the inpatient
psychiatric units of adult, geriatric and child units of MetroWest
Medical Center and the outpatient Partial Psychiatric Program and
ECT Program to coordinate clinical information and perform ongoing
concurrent reviews. The UR individual will interact collaboratively
with the clinical staff on each of the units in order to provide
information to payers for authorizations. UR is responsible for
facilitating the discharge documentation online for the different
payers and will coordinate the incentive programs for ongoing
documentation for all payers.
- Obtains ongoing authorization for appropriate continuation of
level of care for geriatric, adult, child units, Partial
Psychiatric Hospitalization and Outpatient/Inpatient ECT
- Analyzes specific utilization problems, and plans and
implements solutions that directly influence quality of care,
financial liability, and fiscal responsibility.
- Interacts with physicians and other members of the provider
clinical teams for discharge planning
- Performs timely and thorough telephonic case review for
pre-admission and continuing care authorization
- Supports the Director of Emergency Services with the Tufts
Capitated insurance population by authorizing appropriate out of
network services when indicated and maintaining accurate
- Performs concurrent reviews for inpatient care and other levels
- Interacts with providers and facilities in a professional,
respectful manner that facilitates the treatment process
Must have prior experience working in UR and strong working
knowledge of the behavioral health system.
Minimum preferred education Bachelors with strong background in
Utilization Review. Other candidates will be considered if their
experience is commensurate with job requirements.
Must have strong working knowledge of criteria for inpatient
psychiatric admission both for voluntary and involuntary
Strong working knowledge of Massachusetts Statutes governing
criteria for commitability to inpatient locked unit and unlocked
Excellent telephone skills, interpersonal skills and the ability
to build positive, collegial relationships with reviewers.
Must be organized and able to manage multiple points of
- Proven record of working with timelines and high volume.
Keywords: Tenet Healthcare Corporation, Boston , Utilization Reviewer 40 hrs days Psych Administration, Other , Natick, Massachusetts
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