Utilization Review Specialist, Behavioral Health

Lifepoint Health • Mckinney, TX

12h

About The Position

Collin Springs-Changes Plano is part of Lifepoint Health
[https://lifepointhealth.net/locations], 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 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.

Requirements

• Applicants should have a Bachelor’s degree (required), Master’s degree preferred.
• Current unencumbered clinical license strongly preferred
• CPR and CPI Certification within 30 day of employment
• Previous utilization review experience in a psychiatric healthcare facility preferred.

Responsibilities

• Displays knowledge of clinical criteria, managed care requirements for inpatient and outpatient authorization and advocates on behalf of the patient to secure coverage for needed services
• Completes pre and re-certifications for inpatient and outpatient services.
• Reports appropriate denial, and authorization information to designated resource.
• Actively communicates with interdisciplinary team to acquire pertinent information and give updates on authorizations.
• Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.
• Works with DON to ensure documentation requirements are met.
• Ensure appeals are completed thoroughly and on a timely basis.
• Interface with managed care organizations, external reviews, and other payers.
• Communicate with physicians to schedule peer to peer reviews.
• Accurately report denials.

Benefits

• Comprehensive Benefits: Multiple levels of medical, dental and vision coverage, tailored benefit options for part-time and PRN employees, and more.
• 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