Utilization Review Specialist - Behavioral Health

Lifepoint Health®; Lafayette (IN); On-site; USD 60,000 - 84,000; Full time

Benefits offered by this job

Health insurance

401K benefits

Paid time off

Employee assistance program

Tuition reimbursement

Job summary

Sycamore Springs, part of Lifepoint Health, in Layfette, IN, seeks a dedicated Utilization Review Specialist to conduct clinical reviews of admissions and continued stays, advocating for patient access and coordinating with managed care. A Bachelor's Degree is required, with UR experience in psychiatric care preferred.

The role supports a broad patient-care mission and a collaborative treatment team. Eligible candidates will enjoy Lifepoint Health's comprehensive benefits and opportunities for

Qualifications

• Bachelor's Degree required.
• Previous utilization review experience in a psychiatric healthcare facility preferred.

Responsibilities

• Facilitates clinical reviews on all patient admissions and continued stays.
• Analyzes patient records to determine legitimacy of admission, treatment, and length of stay.
• Interfaces with managed care organizations, external reviewers and other payers.
• Advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to managed care providers.
• Contacts external case managers/managed care organizations for certification of insurance benefits during stay.
• Assists the treatment team in understanding requirements for continued stay and discharge planning.

Education

Bachelor's Degree

Job description

Your Experience Matters

At Sycamore Springs, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.

What We Offer

Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers:

• Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
• Competitive Paid Time Off
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Tuition Reimbursement/Assistance for qualified applicants
• And much more...

About Us

People are our passion and purpose. Sycamore Springs is a 48 bed hospital located in Layfette, IN and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone-your experience matters

How You'll Contribute

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 managed 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.

Essential Functions

• Displays knowledge of clinical criteria, managed care requirements for inpatient and outpatient authorization and advocates on behalf of the patient to secure coverage for needed services
• Completes pre and re-certifications for inpatient and outpatient services. Reports appropriate denial, and authorization information to designated resource.
• Actively communicates with interdisciplinary team to acquire pertinent information and give updates on authorizations.
• Participate in treatment teams to ensure staff have knowledge of coverage and to collect 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.
• Accurately report denials.

Qualifications And Requirements

Bachelor's Degree

Previous utilization review experience in a psychiatric healthcare facility preferred.

EEOC Statement

Sycamore Springs is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.