Utilization Review Specialist, Behavioral Health
About The Position
At Jefferson Regional Specialty Hosp White Hall, we are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. Here, you're not just valued as an employee, but as a person. As a Utilization Review Specialist 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. The Utilization Review Specialist conducts clinical reviews for all patient admissions and continued stays, evaluating medical records to determine the necessity of treatment and appropriate length of stay. They serve as a liaison with managed care organizations, external reviewers, and other payers to secure coverage and advocate for patients with substance use disorders, dual diagnoses, and psychiatric or emotional conditions. Throughout the patient's stay, the specialist maintains contact with external case managers to certify insurance benefits and supports the treatment team by clarifying payer requirements for continued care and discharge planning.
Requirements
- Bachelor's degree in healthcare related field with an emphasis on behavioral health required. Master's degree preferred.
- Previous utilization review experience in a psychiatric healthcare facility preferred.
- Current unencumbered clinical license in LPC, LCSW, LMFT, LPN or RN; required.
- CPR certification and Crisis Prevention Training (CPI) preferred.
- May be required to work flexible hours and overtime
Nice To Haves
- Master's degree preferred.
- Previous utilization review experience in a psychiatric healthcare facility preferred.
- CPR certification and Crisis Prevention Training (CPI) preferred.
Responsibilities
- Demonstrates expertise in clinical criteria and managed care requirements to secure inpatient and outpatient service authorizations, including pre-certifications, re-certifications, and appeals.
- Collaborates with interdisciplinary teams, treatment staff, and physicians to gather and share authorization updates, schedule peer reviews, and ensure documentation standards are met.
- Interfaces with managed care organizations and payers, accurately reports denials, and communicates authorization outcomes to designated resources.
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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Industry
Hospitals
Number of Employees
5,001-10,000 employees
