Specialist, Utilization Review
About The Position
Centra Behavioral Health Hospital is seeking a Specialist, Utilization Review to support coverage and medical-necessity review for inpatient and outpatient behavioral health services. The role applies clinical criteria and managed care authorization requirements, advocates for patients seeking coverage of medically necessary services, and reviews clinical documentation to inform treatment and length-of-stay determinations. The specialist completes initial and concurrent authorizations, including pre-certifications and re-certifications, and communicates approval, denial, and authorization details to designated stakeholders. The position is based at Centra Behavioral Health Hospital, a new 72-bed behavioral health facility serving the Lynchburg community. The role is listed as day shift and has an hourly range of $23.98–$32.37.
Requirements
- Bachelor’s degree in business administration, counseling, social work, nursing, or a related behavioral health field from an accredited school.
- De-escalation certification is required within 30 days of employment and before any patient contact.
Nice To Haves
- Clinical, Social Work, or Nursing license preferred.
- One year of utilization review or management experience in behavioral health preferred.
Responsibilities
- Apply working knowledge of clinical criteria and managed care authorization requirements for inpatient and outpatient levels of care.
- Advocate on behalf of patients to obtain coverage for medically necessary services.
- Complete initial and concurrent authorizations, including pre-certifications and re-certifications, for inpatient and outpatient services.
- Communicate approval, denial, and authorization details accurately to designated stakeholders.
- Review and analyze patient clinical documentation to support medical necessity, appropriate treatment, and length-of-stay determinations.
Benefits
- Multiple levels of medical, dental, and vision coverage for full-time and part-time employees.
- Life, accident, critical illness, and hospital indemnity insurance.
- Short- and long-term disability coverage.
- Paid family leave and paid time off.
- Higher education and certification tuition assistance.
- Loan assistance.
- 401(k) retirement package with company match.
- Mental, physical, and financial wellness programs, including free gym memberships, virtual care appointments, mental health services, and discount programs.
- Ongoing learning and career advancement opportunities.
- Brand-new hospital with cutting-edge equipment and technology.
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What This Job Offers
Job Type
Full-time
