Utilization Review Clerk

Lifepoint Health • Avondale, AZ

4h

About The Position

Copper Springs is part of Lifepoint Health, a diversified healthcare delivery
network with facilities coast to coast. We are driven by a profound commitment
to prioritize your well-being so you can provide exceptional care to others. As
a Utilization Review Clerk joining our team, you’re embracing a vital mission
dedicated to making communities healthier ®. Join us on this meaningful journey
where your skills, compassion and dedication will make a remarkable difference
in the lives of those we serve.

A Utilization Review Clerk who excels in this role:

Obtains prior authorizations and ensures all medical services, procedures,
and medications meet insurance requirements prior to delivery.
Serves as a key liaison between Clinical Intake and UR Specialists to help
prevent coverage gaps.

Requirements

• High school diploma required. Two years of experience in a behavioral health setting may substitute for an associate or bachelor’s degree. An associate or bachelor’s degree in a health-related field is preferred.
• Background in a medical setting with experience in insurance coordination, verification, medical terminology, case manager, discharge coordinator or behavioral health setting.
• Proficiency with EMR systems (Meditech or Medik), Microsoft Office applications (Excel, Outlook), and insurance portals such as Availity, AZ Complete, and Optum Star.
• Ability to manage high-volume cases, in a high stress environment by completing time sensitive requests and effectively resolve authorization denials.

Responsibilities

• Complete Precerts for IP & OP/Secure Authorizations: Initiate and secure pre-authorizations for inpatient and outpatient services through insurance portals, phone, or fax.
• Insurance Verification: Confirm patient eligibility, benefits, and coverage limits with the business office before precerting. Communicate all updates or status changes directly to the UR Specialist and document that information in the EHR.
• Documentation & EHR Management: Update Meditech with approval numbers, status updates, and denied dates of service.
• Upload and attach authorization approvals or denials to OnBase MR & scan completed packets to UR the Share drive.
• Complete prior authorization request documentation for major payers, including Banner, Health Choice, Molina, Allwell, Wellcare, and Cigna.
• Record Keeping: Maintain detailed insurance logs and ensure all patient chart documentation in Meditech remains current.
• Departmental Support: The UR Manager may assign other UR related task to be completed as needed.

Benefits

• Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Professional Development: Ongoing learning and career advancement opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED