Utilization Review Specialist

Lifepoint Health • Olathe, KS

2d • Onsite

About The Position

The Utilization Review Specialist facilitates clinical reviews for patient admissions and continued stays. The role analyzes patient records to assess the legitimacy of admissions, treatment, and length of stay, and interfaces with managed care organizations, external reviewers, and other payers. The specialist advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric, or emotional disorders to help ensure necessary treatment. The role also contacts external case managers and managed care organizations to certify insurance benefits throughout a patient’s stay and helps the treatment team understand insurers’ requirements for continued stay and discharge planning.

Cottonwood Springs is a 108-bed hospital in Olathe, Kansas, and is part of Lifepoint Health, a diversified healthcare delivery network with acute care, rehabilitation, and behavioral health facilities.

Requirements

• Bachelor’s degree required.
• 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.
• Current unencumbered clinical license preferred.
• CPR certification preferred.
• Crisis Prevention Training (CPI) preferred.

Responsibilities

• Facilitate clinical reviews for patient admissions and continued stays.
• Analyze patient records to determine the legitimacy of admissions, treatment, and length of stay.
• Interface with managed care organizations, external reviewers, and other payers.
• Advocate for patients with substance abuse, dual diagnosis, psychiatric, or emotional disorders to support access to necessary treatment.
• Contact external case managers and managed care organizations to certify insurance benefits throughout patients’ stays.
• Assist the treatment team in understanding insurance requirements for continued stay and discharge planning.

Benefits

• Comprehensive medical, dental, and vision plans, plus flexible-spending and health-savings accounts.
• Competitive paid time off.
• Income-protection programs, including life, accident, critical-injury insurance, short- and long-term disability, and identity theft coverage.
• Tuition reimbursement and 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