Utilization Review Specialist

Memorial Physician Practices; Oklahoma City, Northern (OK, KY); Hybrid; USD 60,000 - 78,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

HSA/FSA options

Paid time off

Job summary

Oakwood Springs is seeking a Utilization Review Specialist to support inpatient and outpatient authorization processes. You will analyze patient records, advocate for necessary services, and coordinate with care teams and payers.

The role emphasizes collaboration, documentation accuracy, and timely approvals within a psychiatric healthcare setting.

Qualifications

• Bachelor's degree required; master's preferred.
• Experience in utilization review in psychiatric care preferred.
• Current unencumbered clinical license strongly preferred.
• CPR certification and CPI training preferred.

Responsibilities

• Demonstrates knowledge of clinical criteria and managed care requirements for inpatient/outpatient authorization.
• Completes pre- and re-certifications for inpatient and outpatient services.
• Communicates with interdisciplinary team to update on authorizations.
• Collaborates with case managers and payers to secure coverage for needed services.
• Ensures documentation and appeals are thorough and timely.
• Schedules peer-to-peer reviews with physicians.
• Interfaces with managed care organizations and external reviewers.
• Reports denials accurately.
• Performs other duties as assigned.

Skills

Utilization review

Clinical communication

Interdisciplinary teamwork

Payer interfaces

Education

Bachelor's degree

Master's degree

Job description

Your experience matters

At Oakwood Springs, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.

How you'll contribute

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 managed 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.

Essential Functions

• 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 duties as assigned.

What we offer

Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers:

• Comprehensive medical, dental, and vision plans, plus flexible-spending and health- savings accounts
• Competitive paid time off
• Income-protection programs, such as life, accident, critical-injury insurance, short- and long-term disability, and identity theft coverage
• Tuition reimbursement, loan assistance, and 401(k) matching
• Employee assistance program including mental, physical, and financial wellness
• Professional development and growth opportunities

Qualifications and requirements

Education: Bachelor's degree required. Master's degree preferred.

Experience: Previous utilization review experience in a psychiatric healthcare facility preferred.

License: Current unencumbered clinical license strongly preferred.

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

About Us

Oakwood Springs is a 72 - bed hospital located in Oklahoma City, OK, and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone-your experience matters.

EEOC Statement

Oakwood Springs is an Equal Opportunity Employer. Oakwood Springs 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.