Clinical Utilization Review Specialist — Care Advocate

Lifepoint Health®; Denver (CO); On-site; USD 35,817 - 45,460; Full time

Benefits offered by this job

Comprehensive benefits

Paid time off & leave

Tuition assistance

401(k) retirement plan with company匹配

Well-being programs

Job summary

Denver Springs Hospital, part of Lifepoint Health, seeks an experienced Utilization Review Specialist to support clinical reviews and ensure appropriate admissions and stays. The role interfaces with managed care organizations and external reviewers to advocate for patient coverage of services and to coordinate with the treatment team on authorization and discharge planning.

Education requires a Bachelor's degree; Master's preferred.

Qualifications

• Knowledge of clinical criteria and managed care requirements for inpatient/outpatient authorization.
• Ability to advocate for patients to secure coverage for needed services.
• Experience coordinating with external reviewers and payers.

Responsibilities

• Facilitate clinical reviews on admissions and ongoing stays.
• Analyze patient records to determine authorization and length of stay.
• Interface with managed care organizations and other payers.
• Communicate with treatment teams to ensure coverage and discharge planning.
• Complete pre- and re-certifications and report denials/authorization info.

Skills

Clinical criteria knowledge

Managed care knowledge

Advocacy

Interdisciplinary communication

Documentation accuracy

Education

Bachelor's degree

Masters preferred

Job description

Denver Springs Hospital, part of Lifepoint Health, seeks an experienced Utilization Review Specialist to support clinical reviews and ensure appropriate admissions and stays. The role interfaces with managed care organizations and external reviewers to advocate for patient coverage of services and to coordinate with the treatment team on authorization and discharge planning.

Education requires a Bachelor's degree; Master's preferred.