Utilization Review Specialist
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Job Location:
Fort Worth, TX - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Utilization Review Specialist
Your experience matters:
AtWellbridgewe 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 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.
Additional responsibilities include:
- 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
- Complete 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.
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 and extended illness bank package for full-time employees
- 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
Qualifications and requirements:
- Bachelors degree required. Masters degree preferred.
- Experience: Previous utilization review experience in a psychiatric healthcare facility preferred.
- Additional Requirements: CPR certification and Crisis Prevention Training (CPI) preferred.
- May be required to work flexible hours and overtime
WellbridgeFort Worth is a full-service behavioral health hospital for adults and seniors. By prioritizing the dignity of our patients individualized treatment and holistic mind-body care the dedicated professionals of Wellbridge are changing the way people think about mental illness and mental healthcare. It is our mission to improve the lives of our patients families and each other.
Patients admitted to the Wellbridge Fort Worth Inpatient Mental Health program receive 24-hour supervised psychiatric treatment and crisis support for mental health issues. Emphasis is on identifying safety risks and needs stabilizing crisis symptoms increasing mental health knowledge aiding the development of symptom management skills and establishing connections with aftercare services to support stability and ongoing treatment.
Wellbridge Fort Worth is a 48-bed inpatient psychiatric hospital providing full-service inpatient and outpatient treatment.
Required Experience:
IC
Key Skills
- Sales Experience
- Crane
- Customer Service
- Communication skills
- Heavy Equipment Operation
- Microsoft Word
- Case Management
- OSHA
- Team Management
- Catheterization
- Microsoft Outlook Calendar
- EHS
About Company
Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 a ... View more
