Utilization Review Specialist

LifePoint Hospitals • Englewood, CO

80d • $30 - $37

About The Position

At Dever Springs LLC, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.

Requirements

• Bachelor's degree required.
• Master's degree preferred.
• 5-10 years of previous utilization review experience in a psychiatric healthcare facility preferred.
• Current unencumbered clinical license strongly preferred.
• CPR certification and Crisis Prevention Training (CPI) preferred.
• May be required to work flexible hours and overtime.

Responsibilities

• Facilitates clinical reviews on all patient admissions and continued stays.
• Analyzes patient records to determine legitimacy of admission, treatment, and length of stay.
• Interfaces with managed care organizations, external reviewers, and other payers.
• Advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders.
• Contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient's stay.
• Assists the treatment team in understanding the insurance company's requirements for continued stay and discharge planning.
• Displays knowledge of clinical criteria and managed care requirements for inpatient and outpatient authorization.
• Completes pre and re-certifications for inpatient and outpatient services.
• Reports appropriate denial and authorization information to designated resource.
• Actively communicates with an interdisciplinary team to acquire pertinent information and give updates on authorizations.
• Works with DON to ensure documentation requirements are met.
• Answers telephone appropriately to department guidelines and avoids excessive transfers.
• Accurately reports denials.

What This Job Offers

• Job Type: Full-time
• Industry: Hospitals
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees