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Utilization Review Specialist, Berkshire Health Systems

Posted on July 23, 2025Written by Berkshire Health Systems

General Description

Berkshire Health Systems is hiring a Utilization Review Specialist.

Are you a Registered Nurse?

Do you have home health coding experience?

Are you looking for a rewarding career? We would love to speak with you.

Berkshire Visiting Nurse Association (BVNA) is hiring a Utilization Review Specialist. This position offers full benefits and generous earned time program.

Apply today!

Essential Job Functions

The Utilization Review Specialist is responsible for evaluating the necessity and appropriateness of services to ensure that they are effective and cost efficient. The Utilization Review Specialist will work in tandem with the Clinical Manager to assist the clinical staff with case management and ensure care is delivered according to BVNA standards/pathways and regulatory requirements. The Utilization Review Specialist will provide direction and act as a resource for Clinical Managers and staff regarding reimbursement. They will organize, complie, and translate medical information into medical codes according to home care coding conventions.

Qualifications

Experience

  • Minimum of three years of work experience in a certified home health agency. Experience with quality assurance or utilization review preferred.
  • Knowledge of current regulations governing third-party reimbursement for home health required.
  • Ability to cooperate, guide, and instruct a multi-disciplinary team required.
  • Ability to exercise independent judgement; demonstrated time management skills; demonstrated ability to facilitate smooth flow of home care patients.
  • Demonstrated ability to conform with Service Excellence Standards.
  • Demonstrated knowledge of Conditions of Participation in home care.
  • Demonstrated general computer skills required. Demonstrated knowledge of Windows, including Microsoft Word, Excel, and email preferred.

Education and Training

  • BSN nursing strongly preferred.
  • Certification in current version of home health coding required.

License, Certification & Registration

  • RN license- Currently licensed as an RN in the state of Massachusetts
  • Driver’s license

Skills

  • Ability to maintain confidentiality.
  • Ability to be flexible regarding work hours.
  • Knowledge of community resources.
  • Demonstrated problem-solving ability.

2025-0130

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