Utilization Review Specialist

Lifepoint Health®; Gilbert (AZ); On-site; USD 60,000 - 80,000; Full time

Job summary

Copper Springs East Behavioral Health in Gilbert, AZ, part of Lifepoint Health, seeks a Utilization Review Specialist to support clinical reviews, admissions decisions, and benefits coordination. You will review records, collaborate with care teams, and coordinate with payers to ensure appropriate services are authorized.

You will liaise with physicians, case managers, and external payers to obtain necessary coverage, assist with discharge planning, and ensure timely communications and accurate

Qualifications

• Bachelor’s degree required (Master’s preferred).
• Licensure: current unencumbered clinical license strongly preferred.

Responsibilities

• Facilitates clinical reviews for all patient admissions and continued stays.
• Analyzes patient records to determine appropriateness of admission, treatment, and length of stay, interfacing with managed care organizations.
• Advocates for patients to obtain necessary treatment with payers and external reviewers.
• Completes pre-certifications and re-certifications for inpatient/outpatient services and reports denials and authorization information.
• Communicates with the interdisciplinary team to obtain information and provide updates on authorizations.
• Ensures documentation requirements are met in collaboration with the Director of Nursing (DON).
• Interacts with managed care organizations and external reviewers to certify insurance benefits throughout the stay.

Education

Bachelor’s degree

Master’s degree

Job description

Your Experience Matters

Copper Springs East Behavioral Health 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 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

A Utilization Review Specialist who excels in this role:

• Facilitates clinical reviews for all patient admissions and continued stays.
• Analyzes patient records to determine the appropriateness of admission, treatment, and length of stay, and interfaces with managed care organizations, external reviewers, and other payers.
• Advocates on behalf of patients with substance use disorders, dual diagnoses, psychiatric conditions, or emotional disorders to managed care providers to obtain necessary treatment.
• Contacts external case managers and managed care organizations to certify insurance benefits throughout the patient's stay and assists the treatment team in understanding insurance requirements for continued stay and discharge planning.
• Demonstrates knowledge of clinical criteria and managed care requirements for inpatient and outpatient authorization, and advocates on behalf of patients to secure coverage for needed services.
• Completes pre-certifications and re-certifications for inpatient and outpatient services and reports denials and authorization information to the designated resource.
• Communicates actively with the interdisciplinary team to obtain pertinent information and provide updates on authorizations.
• Participates in treatment team meetings to ensure staff understand coverage requirements and to gather information for communication with external agencies.
• Works with the Director of Nursing (DON) to ensure documentation requirements are met.
• Ensures appeals are completed thoroughly and in a timely manner.
• Interfaces with managed care organizations, external reviewers, and other payers.
• Communicates with physicians to schedule peer-to-peer reviews.
• Accurately reports denials.

What we’re looking for

• Bachelor’s degree required. Master’s degree preferred.

License

• Current unencumbered clinical license strongly preferred.

Certifications

• CPR certification and Crisis Prevention Training (CPI) preferred. May be required to work flexible hours and overtime.

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 Copper Springs East

Copper Springs East in Gilbert, AZ, located in the greater Phoenix metro area, is a behavioral health hospital providing inpatient and outpatient programs for mental health and addiction. We treat adults and seniors.

Our treatment programs include inpatient mental health and addiction treatment, outpatient Partial Hospitalization Programs (PHP), Intensive Outpatient Programs (IOP), and ECT therapy.

EEOC Statement

Copper Springs East Behavioral Health is an Equal Opportunity Employer. Copper Springs East Behavioral Health 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.