PRN Utilization Review Specialist (UR), Behavioral Health
PRN Utilization Review Specialist (UR), Behavioral Health
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Salary Not Disclosed
1 Vacancy
Job Description
Schedule: PRN As Needed
Your experience matters
How youll contribute
AnUtilization Review Specialistwho excels in this role:
Facilitates clinical reviews on all patient admissions and continued stays.
Analyzes patient records to determine legitimacy of admission treatment and length of stay and interfaces with managed care organizations external reviewers and other payers.
Advocates on behalf of patients with substance abuse dual diagnosis psychiatric or emotional disorders to managed care providers for necessary treatment.
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.
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.
What were looking for
Applicants should have a Bachelors degree (required). Masters degree preferred. Additional requirements include:
- 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
Colling Springsis a 72-bed behavioral health hospitaloffering exceptional care to the McKinney TX community.
EEOC Statement
Collin Springsis an Equal Opportunity Employer.Collin Springsis 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
Part-Time
