Utilization Review Specialist

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

Your Experience Matters

Denver Springs is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Utilization Review Specialist joining our team, you're embracing a vital mission dedicated to making communities healthier ®. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve.

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.

A Utilization Review Specialist Who Excels In This Role

• 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.

Education

Bachelors Required. Masters Preferred.

Schedule

FT, On-site, anytime between 7am-6pm MST (8 hours a day)

Why join us

We Believe That Investing In Our Employees Is The First Step To Providing Excellent Patient Care. In Addition To Your Base Compensation, This Position Also Offers

• Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Professional Development: Ongoing learning and career advancement opportunities.

More About Denver Springs Hospital

Denver Springs is located in Englewood, CO, 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

Hourly range

$26-$33

EEOC Statement

"Denver Springs is an Equal Opportunity Employer. Denver Springs is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment."

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.