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 Healthgrades.

Description: The Utilization Review employee 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.

Job Responsibilities:

Obtains ongoing authorization for appropriate continuation of level of care for geriatric, adult, child units, Partial Psychiatric Hospitalization and Outpatient/Inpatient ECT patients

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 documentation.

Performs concurrent reviews for inpatient care and other levels of care

Interacts with providers and facilities in a professional, respectful manner that facilitates the treatment process

Qualifications:

Must have prior experience working in UR and strong working knowledge of the behavioral health system.

Must have strong working knowledge of criteria for inpatient psychiatric admission both for voluntary and involuntary patients.

Must have strong working knowledge of Massachusetts Statutes governing criteria for commitability to inpatient locked unit and unlocked unit.

Must have excellent telephone skills.

Must have excellent interpersonal skills and be able to build positive, collegial relationships with reviewers.

Must be organized and able to manage multiple points of data.

Must be able to work with timelines and high volume.

Education:

Minimum preferred education Bachelors with strong background in Utilization Review. Other candidates will be considered if their experience is commensurate with job requirements.

Employment practices will not be influenced or affected by an applicant�s or employee�s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.