Utilization Review Specialist, Behavioral Health

Lifepoint Health®; Fort Worth (TX); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Comprehensive benefits

PTO & disability

Tuition assistance

Loan assistance

401(k) plan

Well-being programs

Career development

Job summary

Mesa Springs, part of Lifepoint Health, seeks an Utilization Review Specialist to support inpatient and outpatient coverage decisions. You will validate criteria, complete certifications, report denials, and collaborate with clinicians to secure appropriate services.

The role emphasizes timely appeals, payer coordination, and ongoing communication with care teams to optimize patient access and outcomes.

Qualifications

• Bachelor's degree required; Master's preferred.
• Current unencumbered clinical license strongly preferred.
• CPR and CPI certification within 30 days of employment.
• Previous utilization review experience in psychiatric healthcare preferred.

Responsibilities

• Displays knowledge of clinical criteria and manages inpatient/outpatient authorization.
• Completes pre- and re-certifications for services.
• Reports denials and authorization information to designated resources.
• Communicates with interdisciplinary team for authorizations updates.
• Participates in treatment teams to collect information for communications with agencies.
• Works with DON to ensure documentation requirements are met.
• Ensures timely and thorough appeals.
• Interacts with managed care, external reviews, and payers.
• Schedules peer-to-peer reviews with physicians.

Skills

Clinical knowledge

Communication

Team collaboration

Education

Bachelor's degree

Master's degree

Job description

Your Experience Matters

Mesa Springs 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®. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve.

How You'll Contribute

An Utilization Review Specialist who excels in this role:

• 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.

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, tailored benefit options for part‑time and PRN employees, and more.
• 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.

What We're Looking For

Applicants should have a Bachelor's degree (required), Master's degree preferred. Additional requirements include

• Current unencumbered clinical license strongly preferred
• CPR and CPI Certification within 30 day of employment
• Previous utilization review experience in a psychiatric healthcare facility preferred.

More about Mesa Springs

Mesa Springs is a behavioral health hospital offering exceptional care to the Fort Worth, TX community.

EEOC Statement

Mesa Springs is an Equal Opportunity Employer. Mesa 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.