Utilization Review Specialist

Springstone • Olathe, KS

495d

About The Position

As a Utilization Review Specialist at Springstone, Inc., you will play a crucial role in the Utilization Review department, which is essential to fulfilling our mission of "Changing People's Lives®". This position is fully on-site at Cottonwood Springs, a 72-bed behavioral hospital located in Olathe, KS, which provides inpatient and outpatient mental health and addiction treatment to adults, adolescents, and their families. You will be part of a highly engaged team that values healthy staffing levels and offers flexible scheduling, competitive compensation, and opportunities for career growth. In this role, you will act as a liaison between managed care organizations and the facility's behavioral health clinical treatment team. Your primary responsibilities will include conducting clinical reviews in accordance with the certification requirements of insurance plans or other managed care organizations. You will monitor patient length of stay and conduct initial and concurrent reviews as needed to provide clinical information that supports medical necessity criteria for the appropriate level of care. Additionally, you will facilitate peer-to-peer reviews between the facility treatment provider and the managed care physician, ensuring that all necessary documentation is completed accurately and timely. You will also assist the Assessment Department with the precertification process for admissions and provide ongoing support and training for staff on documentation requirements, admission and continued stay criteria, and updates on medical necessity. This position requires strong communication skills to effectively interact with patients, internal and external treatment providers, and managed care clinical review care managers. You will need to be detail-oriented, capable of multi-tasking, and possess critical thinking skills to prioritize tasks and work both independently and as part of a team.