Behavioral Health Utilization & Authorization Specialist

Lifepoint Health, Inc.; Gilbert (AZ); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Life insurance

Disability insurance

Paid time off

Tuition assistance

Loan assistance

401(k) retirement plan with company</n

Job summary

Copper Springs East Behavioral Health in Gilbert, AZ is seeking a dedicated Utilization Review Specialist to help coordinate clinical reviews and insurer authorizations, ensuring medical necessity and appropriate patient care.

You will collaborate with physicians, nurses, therapists, and other care team members, advocate for patients with substance use disorders and behavioral health needs, and ensure documentation supports treatment decisions and transitions of care.

Qualifications

• Bachelor's degree required; master's preferred.
• Current, unencumbered clinical license strongly preferred.
• CPR certification and Crisis Prevention Training (CPI) preferred.
• Strong written and verbal communication skills; attention to detail and organizational skills; ability to manage competing priorities and collaborate with clinical professionals, insurance representatives, and other stakeholders.

Responsibilities

• Coordinate clinical reviews for patient admissions and continued stays, ensuring information supports medical necessity.
• Review patient records and clinical documentation to evaluate admissions, treatment plans, and lengths of stay.
• Work with insurance companies and payers to obtain authorizations for inpatient and outpatient services.
• Advocate for patients to secure coverage for medically necessary care.
• Collaborate with physicians, nurses, therapists, and other treatment team members to communicate authorization requirements.
• Help the treatment team understand insurance requirements that affect continued treatment and discharge planning.
• Complete pre-certifications, re-certifications, and clinical reviews accurately within established timeframes.
• Coordinate peer-to-peer reviews between physicians and insurance representatives when necessary.
• Assist with insurance denials and appeals with complete documentation.
• Work with nursing leadership to ensure clinical documentation meets requirements.
• Maintain accurate records and communicate updates to designated team members.

Skills

Motivated to learn

Collaborative

Interest in healthcare and patientadv

Education

Bachelor's degree required

Master's degree preferred

Job description

Copper Springs East Behavioral Health in Gilbert, AZ is seeking a dedicated Utilization Review Specialist to help coordinate clinical reviews and insurer authorizations, ensuring medical necessity and appropriate patient care.

You will collaborate with physicians, nurses, therapists, and other care team members, advocate for patients with substance use disorders and behavioral health needs, and ensure documentation supports treatment decisions and transitions of care.