Utilization Review Specialist

Desert Parkway Behavioral Healthcare Hospital; Las Vegas (NV); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Vision insurance

Dental insurance

401K Retirement Plan

Healthcare spending account

Dependent care spending account

PTO Plan with holiday premium pay

Discounted cafeteria meal plan

Life insurance

Short- and long-term disability

Job summary

Desert Parkway Behavioral Healthcare Hospital is seeking a detail-oriented Utilization Review Specialist to maximize patient care quality and ensure efficient insurance operations. The UR Specialist reviews medical records for clinical necessity and regulatory standards, serving as the bridge between medical staff and insurers, handling authorizations and appeals, and tracking utilization trends.

Hours are Monday through Friday, 8:00am to 4:30pm; requires current licensure and 2+ years of

Qualifications

• LPN, RN or other clinical licensure and/or master’s degree required.
• Minimum 2 years of clinical experience; 1+ year in utilization review or case management.
• Knowledge of Nevada payors; behavioral health experience preferred.

Responsibilities

• Evaluate outpatient charts against established clinical criteria.
• Submit and track insurance authorization requests.
• Draft and submit clinical appeals for denied services.
• Communicate directly with insurance medical directors and case managers.
• Advise physicians and clinical staff on documentation requirements.
• Monitor utilization trends, denial rates, and approval timelines.
• Ensure adherence to Medicare, Medicaid, and private payer guidelines.
• Hours are Monday - Friday from 8:00am - 4:30pm.

Skills

Attention to detail

Clinical documentation

Education

RN or LPN or other clinical licensure, or master’s degree

Tools

Microsoft Word

Microsoft Excel

Job description

We are looking for a detailed-oriented Utilization Review (UR) Specialist to help us maximize patient care quality and ensure seamless insurance operations.

The UR Specialist evaluates patient medical records to ensure treatments meet clinical necessity and regulatory standards. You will serve as the primary bridge between our medical staff and insurance providers, facilitating timely care approvals and minimizing claim denials.

Other responsibilities include retrieving discharge documents on a daily basis from charts, faxing when applicable, and retrieving authorizations.

KEY RESPONSIBILITIES

• Evaluate outpatient charts against established clinical criteria.
• Submit and track insurance authorization requests.
• Draft and submit clinical appeals for denied services.
• Communicate directly with insurance medical directors and case managers.
• Advise physicians and clinical staff on documentation requirements.
• Monitor utilization trends, denial rates, and approval timelines.
• Ensure adherence to Medicare, Medicaid, and private payer guidelines.
• Hours are Monday - Friday from 8:00am - 4:30pm

• Current LPN, RN or other Clinical Licensure and/or master’s degree required.
• Minimum two (2) years of clinical experience, with 1+ years in utilization review or case management required
• Knowledge of Nevada Payors required
• Previous experience working in behavioral healthcare strongly preferred
• Strong Microsoft word and excel skills required
• Maintains confidentiality of patients at all times

Eligible for benefits 1st of the month following one month of employment.

Desert Parkway offers competitive benefits to include:

• Health insurance
• Vision insurance
• Dental insurance
• 401K Retirement Plan
• Healthcare spending account
• Dependent care spending account
• PTO Plan with holiday premium pay
• Discounted cafeteria meal plan
• Life insurance (Supplemental Life, Term and Universal plans are also available)
• Short- and long-term disability (with additional buy-in opportunities)