Utilization Review Specialist

Lifepoint Health • Englewood, CO

5h • $26 - $33 • Onsite

About The Position

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

The position is full-time and on-site in Englewood, Colorado, with an eight-hour workday scheduled anytime between 7:00 a.m. and 6:00 p.m. Mountain Time.

Requirements

• Bachelor’s degree required.
• Knowledge of clinical criteria and managed care requirements for inpatient and outpatient authorization.

Nice To Haves

• Master’s degree preferred.

Responsibilities

• Facilitate clinical reviews for patient admissions and continued stays.
• Analyze patient records to assess admission, treatment, and length-of-stay legitimacy.
• Advocate with managed care providers for coverage of necessary patient services.
• Complete pre-certifications and recertifications for inpatient and outpatient services.
• Report denial and authorization information to designated resources, and accurately report denials.
• Communicate with the interdisciplinary team to obtain relevant information and provide authorization updates.
• Participate in treatment teams to inform staff about coverage and gather information for communication with agencies.
• Work with the Director of Nursing to ensure documentation requirements are met.
• Complete appeals thoroughly and on time.
• Interface with managed care organizations, external reviewers, and other payers.
• Communicate with physicians to schedule peer-to-peer reviews.
• Contact external case managers and managed care organizations to certify insurance benefits throughout patient stays.
• Help the treatment team understand insurance requirements for continued stays and discharge planning.

Benefits

• Multiple levels of medical, dental, and vision coverage for full-time and part-time employees.
• Life, accident, critical illness, and hospital indemnity insurance.
• Short- and long-term disability insurance.
• Paid family leave and paid time off.
• Higher education and certification tuition assistance.
• Loan assistance.
• 401(k) retirement package with company match.
• Wellness programs, including 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