Onsite Utilization Review Specialist & Patient Advocate

Sycamore Springs Behavioral Health; Lafayette (IN); On-site; USD 60,000 - 75,000; Full time

Benefits offered by this job

Health (Medical, Dental, Vision) and 4

401K Benefits

Competitive Paid Time Off

Employee Assistance Program

Tuition Reimbursement/Assistance

Job summary

Sycamore Springs Behavioral Health seeks a dedicated Utilization Review Specialist to assess admissions and ongoing stays. You will analyze patient records for admission legitimacy, coordinate with managed care, and advocate for appropriate treatment coverage.

The role is fully onsite, five days a week, with opportunities to collaborate across care teams. Applicants should have a Bachelor's Degree and preferred UR experience in psychiatric settings.

Qualifications

• Bachelor's Degree (field not specified in posting).
• Previous utilization review experience in a psychiatric healthcare facility preferred.

Responsibilities

• Displays knowledge of clinical criteria and managed care requirements for inpatient and outpatient authorization.
• Completes pre and re-certifications for inpatient and outpatient services; reports denial and authorization information to designated resource.
• Actively communicates with interdisciplinary team to obtain pertinent information and provide updates on authorizations.
• Participates in treatment teams to ensure staff have knowledge of coverage and to gather 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 and report denials accurately.

Education

Bachelor's Degree

Job description

Sycamore Springs Behavioral Health seeks a dedicated Utilization Review Specialist to assess admissions and ongoing stays. You will analyze patient records for admission legitimacy, coordinate with managed care, and advocate for appropriate treatment coverage.

The role is fully onsite, five days a week, with opportunities to collaborate across care teams. Applicants should have a Bachelor's Degree and preferred UR experience in psychiatric settings.