Utilization Review Specialist

Lifepoint Health®; Tucson (AZ); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical, dental & vision

Life & disability insurance

Paid family leave & PTO

Tuition assistance

Loan assistance

401(k) with company match

Mental health programs

Career development

Job summary

Lifepoint Health invites applications for a Utilization Review Specialist at El Dorado Springs Behavioral Health. This role supports admissions reviews, treatment authorization, and discharge planning within our psychiatric care setting.

You will collaborate with the care team and payers to ensure appropriate access to services, complete pre-certifications, and communicate denials. A Bachelor's degree is required; a Master's is preferred.

Qualifications

• Bachelor's degree is required; Master's degree preferred.
• Current unencumbered clinical license strongly preferred.
• CPR certification and CPI training preferred.
• Previous utilization review experience in a psychiatric facility preferred.

Responsibilities

• Facilitates clinical reviews for patient admissions and continued stays.
• Analyzes patient records to determine admission appropriateness and length of stay; interfaces with payers.
• Advocates for access to necessary treatment with managed care providers.
• Completes pre-certifications and re-certifications; reports denials and authorization information.
• Interacts with interdisciplinary team to obtain authorization information.
• Schedules peer-to-peer reviews with physicians; communicates denials accurately.

Skills

Utilization review

Education

Bachelor's degree

Master's degree preferred

Job description

Your Experience Matters

El Dorado Springs 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 a Utilization Review Specialist joining our team, you're embracing a vital mission dedicated to making communities healthier.

How You'll Contribute

A Utilization Review Specialist who excels in this role:

• 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 abuse, dual diagnosis, psychiatric, or emotional disorders to managed care providers to ensure access to necessary treatment.
• Contacts external case managers and managed care organizations to obtain certification of insurance benefits throughout the patient's stay and assists the treatment team in understanding requirements for continued stay and discharge planning.
• Demonstrates knowledge of clinical criteria and managed care requirements for inpatient and outpatient authorization, and advocates for coverage of necessary services.
• Completes pre-certifications and re-certifications for inpatient and outpatient services; reports denials and authorization information to the appropriate resource.
• Actively communicates with the interdisciplinary team to obtain pertinent information and provide updates on authorizations.
• Participates in treatment team meetings to ensure staff understand coverage and to gather information for communication with external agencies.
• Collaborates 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.

About Our Team

Driven by a mission to help individuals regain stability and wellness, our multidisciplinary team works collaboratively to provide compassionate care while fostering a supportive, safety-focused workplace culture for our staff and patients alike.

What we're looking for

• Bachelor's degree (required). Master's degree is preferred.

Licenses & Certifications

• Current unencumbered clinical license is strongly preferred.
• CPR certification and Crisis Prevention Training (CPI) preferred.

Experience

• Previous utilization review experience in a psychiatric healthcare facility preferred.

Schedule

Full-time, may be required to work flexible hours and overtime.

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 and part-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 El Dorado Springs

El Dorado Springs features a state-of-the-art facility with over 100 private and semi-private rooms, providing a secure and therapeutic setting focused on comfort, dignity, and healing. Patients receive 24/7 medically supervised care, evidence-based therapy, medication management, and comprehensive discharge and aftercare planning.

Accredited by The Joint Commission and certified by CMS, El Dorado Springs Behavioral Health is committed to delivering relationship-centered, evidence-based care that improves outcomes and supports long-term recovery.

The hospital offers a full continuum of care, including inpatient psychiatric stabilization, medically assisted detox (MAT), Partial Hospitalization Program (PHP), and Intensive Outpatient Program (IOP). These programs are designed to support individuals experiencing acute mental health symptoms, substance use disorders, or co-occurring conditions in a safe, structured environment.

EEOC Statement

El Dorado Springs Behavioral Health is an Equal Opportunity Employer. El Dorado Springs 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.

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.