Specialist, Utilization Review

Lifepoint Health • Lynchburg, VA

1d

About The Position

Centra Behavioral Health Hospital, part of Lifepoint Health, is a new 72-bed behavioral health facility providing evidence-based, compassionate care for a broad range of mental health concerns. The Specialist, Utilization Review supports medically necessary care by reviewing clinical documentation and coordinating managed care authorizations for inpatient and outpatient services. The role advocates for patients seeking coverage and communicates authorization outcomes and details to designated stakeholders. This is a day-shift position.

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/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 insurance.
• 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.
• New hospital facility with cutting-edge equipment and technology.

What This Job Offers

• Job Type: Full-time