Utilization Review Specialist
This job is no longer active.
View similar jobs.
POST DATE 9/16/2016
END DATE 10/16/2016
Westwood Lodge Hospital & Lowell Treatment Center
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.
* 24-Hour Evaluations, Triage, and Admissions
* Inpatient Treatment for Children, Adolescents, and
* Partial Hospitalization for Children, Adolescents,
Westwood Lodge is seeking a Full Time Utilization Review
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.
Education: Registered Nurse Licensure or Masters Degree
in related field from an accredited School. RN Licensure
must be in the Commonwealth of Massachusetts with
Experience: Experience in Managed Care or Utilization
Review with either a provider, insurance or HMO
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.