Utilization Review Specialist, Behavioral Health

Memorial Physician Practices; Fort Worth, Northern (TX, KY); Hybrid; USD 60,000 - 70,000; Full time

Benefits offered by this job

Comprehensive Benefits

PTO & Disability

Tuition assistance

401(k) with company match

Wellness programs

Job summary

Mesa Springs in Fort Worth, TX is seeking a dedicated Utilization Review Specialist to ensure appropriate inpatient and outpatient authorizations, accuracy in denials and certifications, and effective communication with physicians and care teams.

You will apply clinical criteria, coordinate with managed care organizations, complete pre- and post-certifications, and help the treatment team understand coverage.

Qualifications

• Bachelor's degree required
• Master's degree preferred
• Experience in utilization review desirable

Responsibilities

• Apply clinical criteria to determine authorization decisions
• Coordinate pre- and post-certifications for inpatient and outpatient services
• Report denials and authorizations to appropriate stakeholders
• Communicate with interdisciplinary team for updates on authorizations
• Participate in treatment teams to share coverage information
• Collaborate with DON to ensure documentation requirements
• Interface with managed care and external reviews
• Schedule peer-to-peer reviews with physicians
• Ensure timely and thorough appeals

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 Specialistwho 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.