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Exemption Status:

Hiring Range:

Please note that the final offer may vary within this range based on a candidates experience skills qualifications and internal equity considerations.

Schedule Details:

Scheduled Hours:

Shift:

Hours:

Cost Center:

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health everyone is a caregiver regardless of their title or responsibilities. Exceptional patient care academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts and a place where we can help you build the career you deserve. We are more than 20000 employees working together as one health system in a relentless pursuit of healing for our patients community and each other. And everyone in their own unique way plays an important part every day.

I. Major Responsibilities:

1. Reviews data from admission screening to clarify admission diagnosis establish appropriate length of stay and identify potential outliers.
2. Alerts the treatment team of patient coverage from third party payors. Elicits patient information from the treatment team that is detailed descriptive and indicative of current suicidal/ homocidality or inability to care for self-based on their mental illness.

3. Communicates to third party payer on a regular basis the necessary information that justifies patients hospital level of care.

4. Provides admission continued stay and discharge clinical review including clinical reviews to payers in accordance with established standards procedures and policies.

5. Collaborates with physicians and the interdisciplinary team to plan coordinate implement and evaluate patient care.
6. Serves as a resource to the treatment team in relation to timely discharge planning.
7. Acts as a liaison to third party providers to ensure appropriate communication in regard to the implementation of patients treatment.
8. Reviews all charts daily for appropriate utilization of resources.
9. Clarifies third party coverage.

10. Communicate and facilitate the P2P process between physician advisor and payer physician advisor. Documents outcome.
11. Initialize and maintains utilization review worksheet.
12. Assess patients that current clinical presentation is congruent with hospital level of care. Contacts the treatment team as appropriate.

13. Collaborates with the third-party payers to anticipate denial of payment and proactively addresses issues contributing to a potential denial.

14. Collaborates with the Revenue Integrity and Denial teams to help to respond to insurance denials.

15. Documents Insurance denials Avoidable days and Administrative Necessary days in the patient EMR.

Standard Staffing Level Responsibilities:

1. Complies with established departmental policies procedures and objectives.
2. Attends variety of meetings conferences seminars as required or directed.
3. Demonstrates use of Quality Improvement in daily operations.
4. Complies with all health and safety regulations and requirements.
5. Respects diverse views and approaches demonstrates Standards of Respect and contributes to creating and maintaining an environment of professionalism tolerance civility and acceptance toward all employees patients and visitors.
6. Maintains regular reliable and predictable attendance.
7. Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

II. Position Qualifications:

License/Certification/Education:

Required:
1. Masters degree in psychology counseling or Human Services or equivalent.

Experience/Skills:

Required:
1. Minimum of 3-5 years direct clinical experience.
2. Must have excellent negotiation skills as well as good written and verbal communication skills.
3. Prior working knowledge of psych medications helpful.
4. Assertive and creative in problem solving systems planning and patient care management.

Preferred:
1. Prior case management experience.
2. Word/Excel experience.
3. Experience with DSM4R coding and Allen Cognitive Level (ACL).

Unless certification licensure or registration is required an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies including age-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job managers will review competencies with position incumbents.

III. Physical Demands and Environmental Conditions:

Position requires work indoors most often in an office environment. However work may also include monitoring patients movements and activities resulting in the need for rapid physical response to unsafe patient movements. This includes standing walking running reaching bending lifting and stooping.

All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability or protected veteran status.

Were striving to make respect a part of everything we do at UMass Memorial Health for our patients our community and each other. Our six Standards of Respect are: Acknowledge Listen Communicate Be Responsive Be a Team Player and Be Kind. If you share these Standards of Respect we hope you will join our team and help us make respect our standard for everyone every day.

As an equal opportunity and affirmative action employer UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race color religion gender sexual orientation national origin age disability gender identity and expression protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability please contact us at We will make every effort to respond to your request for disability assistance as soon as possible.