Utilization Review Specialist

Copper-Springs-1; Gilbert (AZ); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Comprehensive Benefits

Financial Protection & PTO

Financial & Career Growth

Employee Well-being

Professional Development

Job summary

Copper Springs East Behavioral Health is seeking an Utilization Review Specialist in Gilbert, AZ. You will facilitate clinical reviews for admissions and stays, interface with payers for authorization, and advocate for patients to obtain needed services. A clinical license is preferred and CPR/CPI certifications are desirable.

Full-time position with comprehensive benefits and opportunities for professional development within Lifepoint Health’s network.

Qualifications

• Bachelor’s degree required; Master’s degree preferred.
• Current unencumbered clinical license preferred.
• CPR certification and CPI preferred.

Responsibilities

• Facilitates clinical reviews for admissions and continued stays.
• Interfaces with payers and external reviewers to verify coverage.
• Advocates for patients to obtain necessary treatment with managed care.
• Completes precertifications and recertifications for services.
• Communicates with the team to update on authorizations.
• Works with DON to ensure documentation requirements are met.

Skills

Utilization review

Clinical documentation

Payer communications

Interdisciplinary coordination

Education

Bachelor'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

• 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

Education:

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

License

• Current unencumbered clinical license is strongly preferred.

Certifications

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

Schedule

Full-time

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 andpart-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.