Utilization Review Specialist
Utilization Review Specialist
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Job Description
Job TitleUtilization Review Specialist
Job Type: FT Monday-Friday 7am-4pm MST (Onsite)
Wage scale: $30-37/hr
Your experience matters at Dever Springs
At Dever Springs LLC we are committed to empowering and supporting a diverse and determined workforce who can drive quality scalability and significant impact across our hospitals and your role youll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.
How youll contribute
Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy of admission treatment and length of stay and interfaces with managed care organizations external reviewers and other payers. UR advocates on behalf of patients with substance abuse dual diagnosis psychiatric or emotional disorders to manage care providers for necessary treatment. UR contacts external case managers/managed care organizations for certification of insurance benefits throughout the patients stay and assists the treatment team in understanding the insurance companys requirements for continued stay and discharge planning.Additional responsibilities include:
Display knowledge of clinical criteria manage care requirements for inpatient and outpatient authorization and advocate on behalf of the patient to secure coverage for needed services
Complete pre and re-certifications for inpatient and outpatient services. Reports appropriate denial and authorization information to designated resource.
Actively communicate with an interdisciplinary team to acquire pertinent information and give updates on authorizations.
Working with DON to ensure documentation requirements are met.
Answers telephone appropriate to department guidelines and avoids excessive transfers.
Interface with managed care organizations external reviews and other payers.
Accurately report denials.
Qualifications and requirements
Bachelors degree required
Masters degree preferred
5-10 of 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.
About Us
Denver Springs located in Englewood CO and is part ofLifepoint Health a diversified healthcare delivery network committed to making communities healthier with acute care rehabilitation and behavioral health facilities from coast to coast. From your first day to your next career milestoneyour experience matters
EEOC Statement
Denver Springs is an Equal Opportunity Employer. Denver Springs is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
