Utilization Review Specialist PRN, Behavioral Health

PRN Position for Inpatient and Outpatient (PHP/IOP) Utilization.

Your experience matters

Mesa Springs is part of Lifepoint Health [https://lifepointhealth.net/locations], a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Utilization Review Specialist joining our team, you’re embracing a vital mission dedicated to making communities healthier®. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve.

How you’ll contribute

An Utilization Review Specialist who excels in this role

• 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 we’re looking for Applicants should have a Bachelor’s degree (required), Master’s degree preferred. Additional requirements include:
• Current unencumbered clinical license strongly preferred
• CPR and CPI Certification within 30 day of employment
• Previous utilization review experience in a psychiatric healthcare facility preferred.

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