Utilization Review Specialist

Lifepoint Health • Lynchburg, VA

4d

About The Position

Behavioral Health Technician Job Type: Full Time, Days Your experience matters At Centra Behavioral Health Hospital, 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. Come join us in our journey of opening a brand-new hospital! Why join us We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers: 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. Brand new facility: Brand new hospital, built from the ground up, with cutting edge equipment and technology! How you'll contribute The Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy of admission, treatment, and length of stay and interfaces with managed care organizations, external reviewers and other payers. UR advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to managed care providers for necessary treatment. UR contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient’s stay and assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning.

Requirements

• Education: Bachelor’s degree required. Master’s degree preferred
• Experience: Previous utilization review experience in a psychiatric healthcare facility preferred.
• License: Current unencumbered clinical license strongly preferred.
• Additional Requirements: CPR certification and Crisis Prevention Training (CPI) preferred.
• May be required to work flexible hours and overtime.

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 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: Mid Level
• Number of Employees: 5,001-10,000 employees