Utilization Review Specialist: Advocate for Timely, Covered Care

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

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.