Utilization Review Specialist

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POST DATE 9/16/2016
END DATE 10/16/2016

Westwood Lodge Hospital & Lowell Treatment Center WESTWOOD, MA

Company
Westwood Lodge Hospital & Lowell Treatment Center
Job Classification
Full Time
Company Ref #
205626
AJE Ref #
576196924
Location
WESTWOOD, MA
Job Type
Regular
Education
Masters Degree

JOB DESCRIPTION

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Description:
Westwood Lodge is a 89-bed private psychiatric hospital
located in Westwood, Mass. The hospital offers a full
continuum of services, including inpatient for children,
adolescents and adults.
Programs Include:
* 24-Hour Evaluations, Triage, and Admissions
* Inpatient Treatment for Children, Adolescents, and
Adults
* Partial Hospitalization for Children, Adolescents,
and Adults
Westwood Lodge is seeking a Full Time Utilization Review
Specialist
JOB PURPOSE:
Responsible for monitoring the effective and efficient
use of health care resources by review of patient
admissions and continued stay appropriateness in all
programs of the hospital. He/she interacts with outside
agencies, third party payers and managed care companies
in accordance with contractual agreements, acting as a
patient advocate and a representative of the hospital.
RESPONSIBILITIES: (include, but not limited to)
Through review of the medical record, assesses the
medical necessity for all admissions based on DSM-IV and
hospital criteria. Concurrently reviews the patient s
treatment through the course of hospitalization to
assure appropriateness of care. Documents criteria and
reviews findings according to established policy and
procedure and protocols.
Requirements:
Education: Registered Nurse Licensure or Masters Degree
in related field from an accredited School. RN Licensure
must be in the Commonwealth of Massachusetts with
current registration.
Experience: Experience in Managed Care or Utilization
Review with either a provider, insurance or HMO
organization.
Technical Skills: Ability to communicate clearly and
effectively through spoken words and in writing.
Age and Disability: Must be able to demonstrate
knowledge and skills necessary to provide interventions
appropriate to the age of the patients with whom he/she
interacts. The individual must demonstrate knowledge of
the principles of growth and development over the life
span, possess the ability to assess data reflective of
the patient s status, and interpret the appropriate
information needed to identify each patient s
requirements relative to his/her age specific needs.
Other: Licensed in the Commonwealth of Massachusetts,
with current registration.