Utilization Review Specialist

Lifepoint Health • Tucson, AZ

6d • Onsite

About The Position

El Dorado Springs Behavioral Health is part of Lifepoint Health, 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. A Utilization Review Specialist who excels in this role: Facilitates clinical reviews for all patient admissions and continued stays. Analyzes patient records to determine the appropriateness of admission, treatment, and length of stay, and 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 managed care providers to ensure access to necessary treatment. Contacts external case managers and managed care organizations to obtain certification of insurance benefits throughout the patient’s stay and assists the treatment team in understanding requirements for continued stay and discharge planning. Demonstrates knowledge of clinical criteria and managed care requirements for inpatient and outpatient authorization, and advocates for coverage of necessary services. Completes pre-certifications and re-certifications for inpatient and outpatient services; reports denials and authorization information to the appropriate resource. Actively communicates with the interdisciplinary team to obtain pertinent information and provide updates on authorizations. Participates in treatment team meetings to ensure staff understand coverage and to gather information for communication with external agencies. Collaborates with the Director of Nursing (DON) to ensure documentation requirements are met. Ensures appeals are completed thoroughly and in a timely manner. Interfaces with managed care organizations, external reviewers, and other payers. Communicates with physicians to schedule peer-to-peer reviews. Accurately reports denials.

Requirements

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

Nice To Haves

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

Responsibilities

• Facilitates clinical reviews for all patient admissions and continued stays.
• Analyzes patient records to determine the appropriateness of admission, treatment, and length of stay, and 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 managed care providers to ensure access to necessary treatment.
• Contacts external case managers and managed care organizations to obtain certification of insurance benefits throughout the patient’s stay and assists the treatment team in understanding requirements for continued stay and discharge planning.
• Demonstrates knowledge of clinical criteria and managed care requirements for inpatient and outpatient authorization, and advocates for coverage of necessary services.
• Completes pre-certifications and re-certifications for inpatient and outpatient services; reports denials and authorization information to the appropriate resource.
• Actively communicates with the interdisciplinary team to obtain pertinent information and provide updates on authorizations.
• Participates in treatment team meetings to ensure staff understand coverage and to gather information for communication with external agencies.
• Collaborates with the Director of Nursing (DON) to ensure documentation requirements are met.
• Ensures appeals are completed thoroughly and in a timely manner.
• Interfaces with managed care organizations, external reviewers, and other payers.
• Communicates with physicians to schedule peer-to-peer reviews.
• Accurately reports denials.

Benefits

• Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Ongoing learning and career advancement opportunities.

What This Job Offers

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