Clinical Utilization Review Specialist Patient Care Advocate

Cottonwood Springs; Olathe (KS); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical, dental, vision plans

Paid time off

Disability and life insurance

Tuition reimbursement

401(k) matching

Employee assistance program (EAP)

Professional development

Job summary

Cottonwood Springs Hospital in Olathe, KS, is seeking a dedicated Utilization Review Specialist to scrutinize patient admissions and stay lengths. You will interface with managed care orgs and external reviewers while advocating for appropriate treatment plans across diverse patient populations.

The role requires collaboration with care teams, review of medical records for admission legitimacy, length of stay, and insurance benefits, and the ability to ensure compliant discharge planning

Qualifications

• Bachelor's degree required; Master's degree preferred.
• Experience in utilization review in a psychiatric healthcare facility preferred.
• Current unencumbered clinical license preferred.
• CPR certification and CPI training preferred. May be required to work flexible hours and overtime.

Responsibilities

• Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays.
• UR analyzes patient records to determine legitimacy of admission, treatment, and length of stay and interfaces with managed care organizations, external reviewers, and other payers.
• UR advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to manage care providers for necessary treatment.
• UR contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient's stay and assists the treatment team in understanding the insurance company's requirements for continued stay and discharge planning.

Education

Bachelor's degree

Master's degree

Job description

Cottonwood Springs Hospital in Olathe, KS, is seeking a dedicated Utilization Review Specialist to scrutinize patient admissions and stay lengths. You will interface with managed care orgs and external reviewers while advocating for appropriate treatment plans across diverse patient populations.

The role requires collaboration with care teams, review of medical records for admission legitimacy, length of stay, and insurance benefits, and the ability to ensure compliant discharge planning