ZipRecruiter

Log In

1

Utilization Review Assistant Jobs in Fall River, MA

Gosnold

Assistant Director of CSS

West Falmouth, MA · On-site

The Assistant Director of CSS oversees clinical reviews to monitor patient progress while ... Participate in utilization review activities in conjunction with other departments to ensure that ...

next page

Showing results 1-20

All JobsUtilization Review JobsUtilization Review Assistant JobsUtilization Review Assistant Jobs in Fall River, MA

Utilization Review Assistant information

What is a utilization review assistant?

A Utilization Review Assistant supports the utilization review process by reviewing medical records, verifying insurance coverage, and ensuring that healthcare services meet necessary guidelines. They assist in gathering documentation, communicating with insurance providers, and coordinating with medical staff to facilitate approvals for treatments. Their role helps ensure that healthcare services are provided efficiently while maintaining compliance with insurance policies and regulations.

What does a utilization review assistant do?

A Utilization Review Assistant typically spends their day reviewing medical records, verifying patient information, and ensuring documentation meets insurance or regulatory requirements. They often work closely with nurses, physicians, case managers, and billing staff to collect necessary data and clarify documentation. The work is usually performed in an office within a hospital, clinic, or insurance company, where prioritizing tasks and maintaining confidentiality are key. This collaborative, detail-oriented environment provides a valuable introduction to healthcare administration and can open doors to broader roles in utilization management or case management.

What skills and qualifications are needed to be a utilization review assistant?

To thrive as a Utilization Review Assistant, you need attention to detail, basic understanding of medical terminology, strong organizational skills, and typically a high school diploma or equivalent. Familiarity with healthcare management software and electronic health records (EHR) systems, along with experience in data entry, is important for this role. Strong communication, problem-solving abilities, and a customer service-oriented attitude help you excel when interacting with clinical staff and patients. These skills are essential for ensuring accurate review processes, compliance with regulations, and effective coordination within healthcare teams.

How do I get into a utilization review assistant?

To become a utilization review assistant, candidates typically need a high school diploma or equivalent, with some roles preferring healthcare-related certifications or experience. Strong organizational skills, attention to detail, and familiarity with medical records and insurance processes are important; some positions may require knowledge of healthcare management software. Gaining relevant experience or certifications can improve job prospects in this field.

What are the most commonly searched types of Utilization Review jobs in Fall River, MA?

The most popular types of Utilization Review jobs in Fall River, MA are:

What are popular job titles related to Utilization Review Assistant jobs in Fall River, MA?

For Utilization Review Assistant jobs in Fall River, MA, the most frequently searched job titles are:

What job categories do people searching Utilization Review Assistant jobs in Fall River, MA look for?

The top searched job categories for Utilization Review Assistant jobs in Fall River, MA are:

What cities near Fall River, MA are hiring for Utilization Review Assistant jobs?

Cities near Fall River, MA with the most Utilization Review Assistant job openings:

Utilization Review Assistant jobs near you
Infographic showing various Utilization Review Assistant job openings in Fall River, MA as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 91% Physical, 3% Hybrid, and 6% Remote job distribution.

LPN - Utilization Review Nurse

High Point Treatment Center

New Bedford, MA • On-site

$32 - $39/hr

Other

Medical, Dental, Vision, Retirement

This job post has expired today. Applications are no longer accepted.

High Point Treatment Center rating

5.7

Company rating: 5.7 out of 10

Based on 12 frontline employees who took The Breakroom Quiz

Job description

LPN - Utilization Review Nurse
Program & Location: Central Utilization Review Department - New Bedford, MA
Qualifications: Graduate of an Accredited Professional School or Nursing or; master's degree in social work, clinical psychology/counseling or mental health preferred with experience in substance use and/or mental health services.
Pay Range: $32 - $39 per hour (experience, education & licensure dependent)
Status: Full Time, 40hrs/week
Shift: Monday-Friday 7:30am-4:00pm
On-Site in New Bedford, MA
About Us
High Point & Affiliated Organizations is a health and human service agency whose mission is to treat and prevent substance use disorders and mental illness. High Point has programs located throughout Southeastern Massachusetts offering a full continuum of care for substance use and mental health treatment, including inpatient, outpatient, residential, and community-based services. Programs and services also assist survivors of abuse, violence, and families experiencing homelessness. High Point believes that everyone has inherent goodness, worth, and dignity. Our goal is to help individuals and families achieve personal change and improve their quality of life.
UR Nurse Requirements:
  • Proficiency with computers, Microsoft Word, email, typing, and other basic office technology.
  • Knowledge of ASAM criteria;
  • Managed care and utilization management experience;
  • Able to organize and structure own workload, attention to detail, and ability to maintain up to date tracking and filing systems;
  • Good clinical judgment, understanding of medical necessity and evidence-based practices;
  • Understanding of boundaries and ethics;
  • Possesses a pleasant telephone manner and customer service skills;
  • Good verbal and written communication skills;
  • The ability to work collaboratively with others in a collaborative and cooperative manner;
  • Understands the diseases of psychiatry and addictions and treatment modalities;
  • Presents professional at all times and allows for flexibility;
  • Problem solving abilities;
  • Critical thinking skills;
  • TB screening;
  • Certification in HPAO De-escalation training;
  • Knowledge of computer programs including Microsoft Office and Electronic Medical Records.
UR Nurse Duties and Responsibilities:
  • Maintains and submits any current Licensure or Certificate necessary for the performance of the position.
  • Compliance with Federal Regulations, 42 CFR Part II, Confidentiality of Alcohol and Drug Abuse Patients and HIPPA
  • Utilization management of all patients, ensuring proper authorization is obtained for all insured inpatient services;
  • Clinical reviews with insurance companies for continued stay, step downs to lower level of care and step ups to higher level of care (except IPU);
  • Responsible for assuring that the business office receives accurate billing information in a timely manner;
  • Keep counselors / nurses of insured patients updated as to their status;
  • Attend daily multi-disciplinary treatment team meetings;
  • Obtain necessary clinical, medical, and treatment information from clinical and medical staff to provide a comprehensive concurrent review;
  • Review all new admissions daily, verifying insurance eligibility, level of care, and obtaining all applicable authorizations;
  • Complete, discharge summary information to insurance companies when applicable;
  • Assist with admission approvals as needed;
  • Attend mandatory meetings and trainings;
  • Attend monthly departmental meetings;
  • Responsible for continued education in the field of substance abuse, nursing and related courses, when necessary;
  • Coordinate and support the initiation and completion of all appeal processes as necessary for insurance claim denials and/or retrospective reviews;
  • Provide assistance and support on the unit when necessary;
  • Utilizes standard precautions at all times;
  • Demonstrates behaviors that recognize the rights of patients as defined by the patient rights;
  • Other duties as assigned by the supervisor.
Benefits:
  • Medical Insurance
  • Dental Insurance
  • Vision Insurance
  • Long & short term disability
  • Discounted auto/home and renters insurance
  • 403b - Retirement
  • FSA & DSA
  • PMLA
  • Employee Assistance Program
  • Bonuses & Referral
  • Eligibility for free classes to become a Licensed Counselor or Recovery Coach
  • Education days to use towards CEU's
  • Free meals at select programs and when available
  • Unmatched Leave Time (FT employees can earn up to 3 weeks in first year)

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

What High Point Treatment Center employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply