Specialist, Utilization Review
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Job Location:
Lafayette, IN - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
Your experience matters
At Sycamore Springswe 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.
What we offer
Fundamental to providing great care is supporting and rewarding our addition to your base compensation this position also offers:
- Health (Medical Dental Vision) and 401K Benefits for full-time employees
- Competitive Paid Time Off
- Employee Assistance Program mental physical and financial wellness assistance
- Tuition Reimbursement/Assistance for qualified applicants
- And much more...
About Us
People are our passion and purpose. Sycamore Springs is a 48 bed hospital located in Layfette IN and is part of Lifepoint 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
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.
Essential Functions:
- 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.
Qualifications and requirements
Bachelors Degree
Previous utilization review experience in a psychiatric healthcare facility preferred.
EEOC Statement:
Sycamore Springs is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color race sex age religion national origin disability genetic information gender identity sexual orientation veterans status or any other basis protected by applicable federal state or local law.
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
