Utilization Review Specialist — Champion Patient Care

Lifepoint Health; Columbus (OH); On-site; USD 65,000 - 86,000; Full time

Benefits offered by this job

Medical, dental, vision

Paid time off

Insurance protection

Tuition reimbursement

Employee assistance program

Professional development

Job summary

Columbus Springs-East, part of Lifepoint Health, seeks a Utilization Review Specialist to perform clinical reviews of patient admissions and stays. The role interfaces with managed care organizations, advocates for appropriate coverage, and coordinates with the treatment team to ensure compliant discharge planning.

The ideal candidate has a Bachelor's degree (Master's preferred), UR experience in psychiatric settings, and an active clinical license; CPR and CPI certification are a plus.

Qualifications

• Bachelor's degree required; Master's degree preferred.
• Previous utilization review experience in a psychiatric healthcare facility preferred.
• Current unencumbered clinical license strongly preferred.
• CPR certification and Crisis Prevention Training (CPI) preferred

Responsibilities

• 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 service.
• 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.

Education

Bachelor's degree

Master's degree

Job description

Columbus Springs-East, part of Lifepoint Health, seeks a Utilization Review Specialist to perform clinical reviews of patient admissions and stays. The role interfaces with managed care organizations, advocates for appropriate coverage, and coordinates with the treatment team to ensure compliant discharge planning.

The ideal candidate has a Bachelor's degree (Master's preferred), UR experience in psychiatric settings, and an active clinical license; CPR and CPI certification are a plus.