Utilization Review Specialist

Lifepoint Health, Inc.; Gilbert (AZ); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Life insurance

Disability insurance

Paid time off

Tuition assistance

Loan assistance

401(k) retirement plan with company</n

Job summary

Copper Springs East Behavioral Health in Gilbert, AZ is seeking a dedicated Utilization Review Specialist to help coordinate clinical reviews and insurer authorizations, ensuring medical necessity and appropriate patient care.

You will collaborate with physicians, nurses, therapists, and other care team members, advocate for patients with substance use disorders and behavioral health needs, and ensure documentation supports treatment decisions and transitions of care.

Qualifications

• Bachelor's degree required; master's preferred.
• Current, unencumbered clinical license strongly preferred.
• CPR certification and Crisis Prevention Training (CPI) preferred.
• Strong written and verbal communication skills; attention to detail and organizational skills; ability to manage competing priorities and collaborate with clinical professionals, insurance representatives, and other stakeholders.

Responsibilities

• Coordinate clinical reviews for patient admissions and continued stays, ensuring information supports medical necessity.
• Review patient records and clinical documentation to evaluate admissions, treatment plans, and lengths of stay.
• Work with insurance companies and payers to obtain authorizations for inpatient and outpatient services.
• Advocate for patients to secure coverage for medically necessary care.
• Collaborate with physicians, nurses, therapists, and other treatment team members to communicate authorization requirements.
• Help the treatment team understand insurance requirements that affect continued treatment and discharge planning.
• Complete pre-certifications, re-certifications, and clinical reviews accurately within established timeframes.
• Coordinate peer-to-peer reviews between physicians and insurance representatives when necessary.
• Assist with insurance denials and appeals with complete documentation.
• Work with nursing leadership to ensure clinical documentation meets requirements.
• Maintain accurate records and communicate updates to designated team members.

Skills

Motivated to learn

Collaborative

Interest in healthcare and patientadv

Education

Bachelor's degree required

Master's degree preferred

Job description

UTILIZATION REVIEW SPECIALIST

Copper Springs East Behavioral Health | Gilbert, Arizona

Your career. Your impact. Your opportunity.

Start building a career that makes a difference.

Are you looking for an opportunity to put your education to work, develop valuable professional skills, and make a meaningful contribution to the healthcare field? At Copper Springs East Behavioral Health, you'll have the opportunity to do all three.

As a Utilization Review Specialist, you'll play an important role in helping patients receive the behavioral healthcare services they need. Working alongside physicians, nurses, therapists, and other healthcare professionals, you'll help coordinate clinical reviews and insurance authorizations, advocate for appropriate patient care, and ensure treatment decisions are supported by the necessary clinical documentation.

This is an excellent opportunity for an emerging healthcare professional who enjoys working with people, has strong analytical and communication skills, and wants to develop a deeper understanding of the intersection between clinical care, healthcare administration, and insurance.

You'll join an established healthcare organization, gain exposure to a multidisciplinary clinical environment, and build experience that can serve as a foundation for long-term professional growth.

And there's a pretty great place to call home, too. Located in Gilbert, Arizona, Copper Springs East offers the opportunity to build your career in the heart of the greater Phoenix area. With abundant sunshine and year-round opportunities to get outside, the region is a natural playground for outdoor enthusiasts. From hiking and mountain biking to boating, paddleboarding, kayaking, and other water sports on nearby lakes, there's no shortage of ways to enjoy life outside of work.

If you're ready to take the next step in your professional journey, we'd like to meet you.

How you'll contribute

• Coordinate clinical reviews for patient admissions and continued stays, ensuring appropriate information is available to support medical necessity and treatment decisions.
• Review patient records and clinical documentation to evaluate the appropriateness of admissions, treatment plans, and lengths of stay.
• Work directly with insurance companies, managed care organizations, external reviewers, and other payers to obtain authorizations for inpatient and outpatient services.
• Advocate for patients receiving treatment for substance use disorders, psychiatric conditions, dual diagnoses, and other behavioral health challenges to help secure coverage for medically necessary care.
• Collaborate with physicians, nurses, therapists, and other members of the interdisciplinary treatment team to communicate authorization requirements and coordinate patient care.
• Help the treatment team understand insurance requirements that may affect continued treatment, transitions of care, and discharge planning.
• Complete pre-certifications, re-certifications, and clinical reviews accurately and within established timeframes.
• Coordinate peer-to-peer reviews between physicians and insurance representatives when necessary.
• Assist with insurance denials and appeals, ensuring supporting clinical documentation is complete and submitted promptly.
• Work with nursing leadership to help ensure clinical documentation meets applicable requirements.
• Maintain accurate records and communicate authorization updates, denials, and other relevant information to designated team members.

What we're looking for

We're interested in candidates who are motivated to learn, comfortable working in a collaborative environment, and genuinely interested in healthcare and patient advocacy.

Education: Bachelor's degree required; master's degree preferred.

Licensure: Current, unencumbered clinical license strongly preferred.

Certifications: CPR certification and Crisis Prevention Training (CPI) preferred.

Additional requirements: Strong written and verbal communication skills; excellent attention to detail and organizational skills; ability to manage competing priorities and collaborate with clinical professionals, insurance representatives, and other stakeholders; willingness to learn clinical review standards, insurance authorization requirements, and applicable guidelines; flexibility to work additional hours when business needs require.

Why join us?

At Copper Springs East, we believe investing in our employees is an important part of delivering exceptional patient care. You'll have the opportunity to learn from experienced healthcare professionals, develop valuable skills, and grow within an established healthcare organization.

Comprehensive Benefits: Multiple levels of medical, dental, and vision coverage for eligible full-time and part-time employees.

Financial Protection & Paid Time Off: Life, accident, critical illness, and hospital indemnity insurance; short- and long-term disability; paid family leave; and paid time off.

Education & Career Advancement: Tuition assistance for higher education and professional certifications, loan assistance, and opportunities for continued learning and career development.

Retirement Planning: 401(k) retirement savings plan with company matching.

Employee Well-being: Mental, physical, and financial wellness programs, including free gym memberships, virtual care appointments, mental health services, and employee discount programs.

More about Copper Springs East

Copper Springs East Behavioral Health is part of Lifepoint Health, a diversified healthcare delivery network with facilities across the country. We are committed to making communities healthier and providing compassionate, high-quality care to the patients and families we serve.

Located in Gilbert, Arizona, Copper Springs East is a behavioral health hospital providing comprehensive inpatient and outpatient treatment programs for adults and seniors experiencing mental health and substance use challenges.

Our services include: Inpatient mental health and addiction treatment; Partial Hospitalization Programs (PHP); Intensive Outpatient Programs (IOP); and Electroconvulsive Therapy (ECT).

Joining our team means becoming part of an organization dedicated to improving lives while giving you the opportunity to develop your own professional capabilities.

Equal Opportunity Employer

Copper Springs East Behavioral Health is an Equal Opportunity Employer. We are committed to providing equal employment opportunities to all applicants and employees and comply 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.