Utilization Review Specialist PRN, Behavioral Health
Lifepoint Health•Fort Worth, TX
About The Position
PRN Position for Inpatient and Outpatient (PHP/IOP) Utilization. Your experience matters Mesa Springs is part of Lifepoint Health [https://lifepointhealth.net/locations], 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.
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.
