Utilization Review Specialist (URS)

Springstone Inc; Lafayette (LA); On-site; USD 50,000 - 80,000; Full time

Job summary

An established industry player in behavioral health is seeking dedicated team members to enhance patient care. This role involves advocating for patients, ensuring compliance with managed care requirements, and collaborating with healthcare professionals. With a focus on compassionate services, the organization offers a supportive work environment, competitive compensation, and flexible scheduling. Join a mission-driven team that is committed to improving mental health outcomes and making a positive impact in the community.

Benefits

Affordable medical, dental, and vision plans

Up to 16 days of PTO

6 paid holidays

Tuition reimbursement

401(k) retirement plan

Flexible spending and health savings accounts

Earned Wage Access benefit

Qualifications

• Bachelor’s degree required; Master’s preferred.
• Previous utilization review experience in psychiatric healthcare preferred.

Responsibilities

• Advocate for patient service coverage with managed care.
• Ensure documentation meets requirements.
• Report authorization and denial information.

Skills

Clinical criteria knowledge

Managed care requirements

Advocacy for patient services

Documentation compliance

Education

Bachelor's degree

Master's degree

Job description

Overview

Sycamore Springs, part of Lifepoint Behavioral Health, nationally known healthcare organization with diversified delivery network with facilities from coast to coast, seeks passionate, patient-centric, and goal-oriented team members to join our team. We specialize in compassionate behavioral health services, including crisis stabilization, inpatient care, and outpatient treatment for acute mental health and substance use treatment. Our philosophy is built on a psychosocial model of care to decrease suicide rates, decrease addiction-related deaths, reverse the decline in life expectancy, and improve productivity in the communities we serve. We offer a collaborative work environment, competitive compensation, and flexible scheduling so you can focus on what really matters–providing quality patient care. Join our team in Lafayette, IN to build a career that touches lives.

Benefits

• Affordable medical, dental and vision plans provided to meet the needs of full employees and their families
• Up to 16 days of PTO for full time employees
• 6 paid holidays for full time employees
• Tuition reimbursement
• 401(k) retirement plan
• Flexible spending and health savings accounts
• UKG Wallet - We've partnered with UKG Wallet, a voluntary Earned Wage Access benefit, to offer employees access to their pay on their own schedule

Position Details

What you will do 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.

• Reports appropriate denial, and authorization information to designated resource.

• Works with DON to ensure documentation requirements are met.

• Interface with managed care organizations, external reviews, and other payers.

• Other duties as assigned.

Qualifications

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. May be required to work flexible hours and overtime