About Us
Bournewood Health Systems is a behavioral health organization with a main campus in Brookline, MA and satellite sites in Woburn, Lowell, and Dedham. We provide acute psychiatric inpatient services and partial hospital/outpatient psychiatric programs. We are dedicated to providing quality, evidence-based and person-centered treatment for people with mental health and substance use conditions in a safe and respectful environment in partnership with the individuals and families we serve, focusing on support, hope and recovery. We are committed to a philosophy and an environment of care in which we treat people with dignity, respect and mutuality; protect their rights; provide the best care possible; support them in returning to their natural communities; and include patients and families as partners in their treatment. We stand firmly for providing a safe and therapeutic environment for patients, families and staff. All Bournewood employees are continuously trained in this philosophy. All candidates must be able and willing to promote the values of trauma-informed and patient-centered care.
Utilization Review Clinician
The Utilization Review Clinician conducts ongoing clinical reviews with various insurers to obtain clinical authorization for the appropriate levels of care. In addition, the UR Clinician will coordinate appeals as requested by the UM Director and participate in or coordinate any data collection needed for QI indicators. The Utilization Reviewer may also act as a liaison and represent the department at the QI Committee meetings.
Essential Functions:
- Monitors and assesses current level of care for assigned cases and recommends changes to the clinical team and/or UM Director; Demonstrates the skills required to organize relevant information and accurately reiterate requirements to MCOs and Treatment Team members
- Conducts clinical reviews with designated insurers and conducts reviews on the appropriate day and at the designated time; Effectively coordinates collection of all pertinent clinical data to support HLOC
- Initiates appeals as requested and completes data collection as requested for QI indicators
- Covers Utilization Management Director’s time away as necessary
- Completes daily discharge forms to respective Insurers
- Performs other duties as assigned or apparent
Education, Licensure or Certifications
- Master level clinician (MSN, MSW, MA etc.) preferred
Work Experience or Related Experience:
- 5 years of experience in behavioral health preferred.
- Experience with utilization review process, and insurances preferred.
- Experience in a behavioral health environment is strongly preferred.
