Specialist, Utilization Review
Specialist, Utilization Review
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Salary Not Disclosed
1 Vacancy
Job Description
Copper Springs (Avondale)
Job Title: Utilization Review Specialist
Job Type: Full Time
Your experience matters
At Copper Springs East we are committed to empowering and supporting a diverse and determined workforce who can drive quality scalability and significant impact across our hospitals and communities.
What we offer
Fundamental to providing great care is supporting and rewarding our addition to your base compensation this position also offers:
Comprehensive medical dental and vision plans plus flexible-spending and health- savings accounts
Competitive paid time off
Income-protection programs such as life accident critical-injury insurance short-and long-term disability and identity theft coverage
Tuition reimbursement loan assistance and 401(k) matching
Employee assistance program including mental physical and financial wellness
Professional development and growth opportunities
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 managed 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.
Minimum Qualifications
Education:
- Bachelors degree required. Masters degree preferred.
Licenses/Certifications
- Current unencumbered clinical license strongly preferred.
- CPR certification and Crisis Prevention Training (CPI) preferred.
Experience:
- Previous utilization review experience in a psychiatric healthcare facility preferred.
Other:
- May be required to work flexible hours and overtime
JOB 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 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.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
