Utilization Review Specialist

Lifepoint Health•Gilbert, AZ

19h

About The Position

The Utilization Review Specialist serves as a link between the clinical treatment team, patients, and insurance providers at Copper Springs East Behavioral Health in Gilbert, Arizona. The role coordinates clinical reviews and insurance authorizations, supports medical-necessity and treatment decisions, and helps ensure clinical documentation supports appropriate patient care. The specialist works with physicians, nurses, therapists, insurance companies, managed care organizations, external reviewers, and other payers across inpatient and outpatient behavioral health services. This position is presented as an opportunity for an emerging healthcare professional to build experience in clinical care, healthcare administration, and insurance. The specialist helps patients with substance use disorders, psychiatric conditions, dual diagnoses, and other behavioral health challenges obtain coverage for medically necessary care. The role also supports authorization processes, treatment transitions, discharge planning, denials and appeals, and communication of authorization updates to relevant team members.

Requirements

Bachelor’s degree required.
Strong written and verbal communication skills.
Excellent attention to detail and organizational skills.
Ability to manage competing priorities and collaborate with clinical professionals, insurance representatives, and other stakeholders.
Willingness to learn clinical review standards, insurance authorization requirements, and applicable guidelines.
Flexibility to work additional hours when business needs require.

Nice To Haves

Master’s degree preferred.
Current, unencumbered clinical license strongly preferred.
CPR certification preferred.
Crisis Prevention Training (CPI) preferred.

Responsibilities

Coordinate clinical reviews for patient admissions and continued stays, ensuring information is available to support medical necessity and treatment decisions.
Review patient records and clinical documentation to evaluate the appropriateness of admissions, treatment plans, and lengths of stay.
Work with insurance companies, managed care organizations, external reviewers, and other payers to obtain authorizations for inpatient and outpatient services.
Advocate for patients receiving behavioral health treatment to help secure coverage for medically necessary care.
Collaborate with physicians, nurses, therapists, and other interdisciplinary treatment team members to communicate authorization requirements and coordinate patient care.
Help the treatment team understand insurance requirements affecting continued treatment, transitions of care, and discharge planning.
Complete pre-certifications, re-certifications, and clinical reviews accurately and within established timeframes.
Coordinate peer-to-peer reviews between physicians and insurance representatives when necessary.
Assist with insurance denials and appeals, ensuring supporting clinical documentation is complete and submitted promptly.
Work with nursing leadership to help ensure clinical documentation meets applicable requirements.
Maintain accurate records and communicate authorization updates, denials, and other relevant information to designated team members.

Benefits

Multiple levels of medical, dental, and vision coverage for eligible full-time and part-time employees.
Life, accident, critical illness, and hospital indemnity insurance.
Short- and long-term disability.
Paid family leave and paid time off.
Tuition assistance for higher education and professional certifications.
Loan assistance.
Continued learning and career development opportunities.
401(k) retirement savings plan with company matching.
Mental, physical, and financial wellness programs.
Free gym memberships.
Virtual care appointments.
Mental health services.
Employee discount programs.