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

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.