Utilization Review Specialist

Lifepoint Health; Hot Springs (AR); On-site; USD 60,000 - 75,000; Full time

Job summary

National Park Medical Center in Hot Springs, AR, is seeking a Utilization Review Specialist to assess admissions and continued stays. You will review records, determine coverage needs, and coordinate with managed care executives and payers to ensure appropriate services.

You will advocate for patients with complex needs, document denials, and collaborate with the treatment team to support discharge planning. A bachelor's degree and UR experience in a psychiatric setting are preferred.

Qualifications

• Bachelor's degree required; master's preferred.
• Previous utilization review experience in a psychiatric facility preferred.
• CPR certification required or preferred.
• License: current unencumbered clinical license preferred.

Responsibilities

• Facilitates clinical reviews on patient admissions and stays.
• Analyzes records to determine legitimacy of admission, treatment, and length of stay.
• Interface with managed care organizations and external reviewers.
• Advocates for patients with psychiatric or emotional disorders to secure needed care.
• Coordinate with care teams and case managers for insurance benefits.
• Ensure documentation and appeals are completed thoroughly and timely.

Skills

Utilization review

CPR certification

CPI training

Psychiatric healthcare experience

Education

Bachelor's degree

Master's degree preferred

Current clinical license preferred

Job description

Who We Are:

People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. National Park Medical Center, a 163-bed full-service hospital, is a forward thinking, innovative hospital where trust, teamwork and technology come together to make a positive difference in the health of our community and region.

Where We Are:

Live where others only get to vacation...Hot Springs, located in the gently rolling Ouachita Mountains, offers a unique combination of natural beauty, cultural life, and historical interest. With numerous outdoor activities, art galleries, local shops, and diverse cuisine, Hot Springs has something for everyone.

Why Choose Us:

• Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
• Competitive Paid Time Off
• Short-term and Long-term disability 100% paid for by the company
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Loan repayment, tuition reimbursement and scholarship opportunities for qualified candidates
• Professional development opportunities, apprenticeship programs, and certification assistance
• And much more...

Position Summary:

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 manage 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. Additional responsibilities include:

• 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.
• Other job duties as assigned.

Minimum Qualifications:

EDUCATION AND/OR EXPERIENCE:

• Bachelor's degree required. Master's degree preferred.
• Previous utilization review experience in a psychiatric healthcare facility preferred.
• License: Current unencumbered clinical license preferred.
• Additional Requirements: CPR certification and Crisis Prevention Training (CPI) preferred. May be required to work flexible hours and overtime.

EEOC Statement:

National Park Medical Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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.