Bluestone Child & Adolescent Psychiatric Hospital·University Heights, Ohio
The UR Specialist independently facilitates clinical reviews for admission and continued stay to ensure medical necessity. They advocate for patients regarding insurance benefits and collaborate with treatment teams and payers to manage authorizations.
Bluestone Child & Adolescent Hospital is seeking dynamic healthcare professionals interested in bringing psychiatric care to a new level for children ages 6-17. Working in a brand new, 12 bed state-of-the-art facility, Bluestone staff will have a unique ability to direct patient care, employ best practices, and join a care network that promotes the best long-term outcomes for patients.
The Utilization Review (UR) Specialist will independently facilitate clinical reviews, as necessary, on admission and for continued stay care. The UR Specialist will review the medical record to ensure medical necessity of admission as well as ongoing inpatient and outpatient treatment. The UR Specialist will determine the avenues for advocacy on behalf of patients with insurance for utilization of insurance benefits throughout the patient’s treatment. The UR Specialist will also respond to intake inquiries via phone, fax and email.
Complete initial, concurrent, and retrospective reviews of patient care in a timely manner to ensure continuous coverage for patients in inpatient treatment.
Initiate, schedule, and meaningfully participate in peer reviews and expedited appeals between third-party payers and facilities as needed.
Maintain sophisticated and current knowledge of mental health disorders including DSM-V knowledge, ICD-10 diagnoses and treatment processes.
Utilize clinical information and knowledge of medical necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners including the admitting psychiatrist.
Collaborate with treatment team to discuss clinical authorization and quality of care.
Consistent and timely response to emails and other communications relating to utilization review.
Prepare and submit appeals utilizing their independent knowledge and expertise.
Familiarity with processing correspondence with adherence to HIPPA guidelines.
Assist with the Intake process for Bluestone admissions, including answering phone calls and reviewing faxed or emailed referrals.
Complete all data tracking as needed.
As relevant to scope of practice, complete psychosocial assessments or group treatment services for either inpatient or outpatient admissions.
Requires an Associate degree in Nursing, Social Work, or Behavioral Sciences and a valid professional license (e.g., RN, LSW, LPC). Candidates should have 1-5 years of related experience, preferably in behavioral health utilization review.
Market context
Behavioral health roles in Ohio are typically in steady demand as employers seek clinicians who can support outpatient, community, and integrated care settings. These positions are competitive because they often require a master’s degree and a valid clinical license, and candidates should note that the requirements and benefits here are AI-summarized from the original job description to save research time. Before applying, confirm licensure fit and prepare examples of direct client care, crisis response, or care coordination.
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