PRN Utilization Review Specialist - Behavioral Health

LifePoint Hospitals•Mckinney, TX

34d

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.

Requirements

Applicants should have a Bachelor's degree (required), Master's degree preferred.
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.

Nice To Haves

Master's degree
Current unencumbered clinical license
Previous utilization review experience in a psychiatric healthcare facility

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.