Utilization Review Pro: Patient Care Coverage

Memorial Physician Practices; Columbus, Northern (OH, KY); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

Flexible spending accounts

Paid time off

Tuition reimbursement

401(k) matching

Employee assistance program

Professional development

Job summary

Columbus Springs-East in Columbus, OH seeks an Utilization Review Specialist to analyze patient admissions and stays, interfacing with managed care to determine authorization and coverage needs. The role focuses on ensuring appropriate care and discharge planning across inpatient and outpatient services.

The ideal candidate has a bachelor's degree with UR experience in psychiatric settings, CPR/CPI training preferred, and a license that supports clinical review responsibilities.

Qualifications

• Bachelor's degree required; Master's degree preferred.
• Previous utilization review experience in a psychiatric healthcare facility preferred.
• Current unencumbered clinical license strongly preferred.
• CPR certification and Crisis Prevention Training (CPI) 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 denials and authorizations to designated resources.
• Active communication with interdisciplinary team to obtain pertinent information and updates on authorizations.
• Interface with managed care organizations, external reviewers, and other payers; coordinate with physicians for peer-to-peer reviews.

Skills

Clinical knowledge

Interdisciplinary collaboration

Team communication

Education

Bachelor's degree

Master's degree

Job description

Columbus Springs-East in Columbus, OH seeks an Utilization Review Specialist to analyze patient admissions and stays, interfacing with managed care to determine authorization and coverage needs. The role focuses on ensuring appropriate care and discharge planning across inpatient and outpatient services.

The ideal candidate has a bachelor's degree with UR experience in psychiatric settings, CPR/CPI training preferred, and a license that supports clinical review responsibilities.