Utilization Review Specialist

Lifepoint Health • Olathe, KS

7d • Onsite

About The Position

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 manage 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

• Bachelor’s degree required.

Nice To Haves

• Master’s degree preferred.
• Previous utilization review experience in a psychiatric healthcare facility preferred.
• Current unencumbered clinical license preferred.
• CPR certification and Crisis Prevention Training (CPI) preferred.

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 to manage care providers for necessary treatment.
• 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.

Benefits

• Comprehensive medical, dental, and vision plans
• Flexible-spending and health-savings accounts
• Competitive paid time off
• Income-protection programs, such as life, accident, critical-injury insurance, short- and long-term disability, and identity theft coverage
• Tuition reimbursement
• Loan assistance
• 401(k) matching
• Employee assistance program including mental, physical, and financial wellness
• Professional development and growth opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level