PRN Utilization Review Specialist - Behavioral Health

Lifepoint Health•McKinney, TX

About The Position

Collin Springs-Changes Plano 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. How you’ll contribute An Utilization Review Specialist who excels in this role: 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. 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: Working with a highly engaged staff Healthy staffing levels Flexible scheduling Career growth Competitive compensation What we’re looking for Applicants should have a Bachelor’s degree (required), Master’s degree preferred. Additional requirements include: Current unencumbered clinical license strongly preferred CPR and CPI Certification within 30 day of employment Previous utilization review experience in a psychiatric healthcare facility preferred. More about Collin Springs Colling Springs is a 72-bed behavioral health hospital offering exceptional care to the McKinney, TX community. EEOC Statement “Collin Springs is an Equal Opportunity Employer. Collin Springs is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.”

Requirements

Bachelor’s degree (required)
CPR and CPI Certification within 30 day of employment

Nice To Haves

Master’s degree preferred
Current unencumbered clinical license strongly preferred
Previous utilization review experience in a psychiatric healthcare facility preferred.

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.