Utilization Review Specialist at Lifepoint Health

DescriptionCopper Springs EastJob Title: Utilization Review SpecialistJob Type: Full-timeYour experience mattersAt Copper Springs East we are committed to empowering and supporting a diverse and determined workforce who can drive quality scalability and significant impact across our hospitals and communities.What we offerFundamental 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 accountsCompetitive paid time offIncome-protection programs such as life accident critical-injury insurance short-and long-term disability and identity theft coverageTuition reimbursement loan assistance and 401(k) matchingEmployee assistance program including mental physical and financial wellnessProfessional development and growth opportunitiesHow youll contributeUtilization 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.Job ResponsibilitiesDisplays 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.Minimum QualificationsEducation:Bachelors degree required. Masters degree preferred.License:Current unencumbered clinical license strongly preferred.Certifications:CPR certification and Crisis Prevention Training (CPI) preferred. May be required to work flexible hours and overtime.Physical Mental and Special DemandsAbility to sit and stand (at least two-thirds of the shift) and walk (possibly one-third of the shift).Ability to reach above or below waist height kneel bend stoop turn and twist (occasionally to frequently).Visual ability to read charts treatment plans financial documents computer screen and typewritten materials.Ability to frequently push/pull wheeled carts to 100 pounds.Ability to frequently lift and carry 10 lbs.; occasionally 20 to 50 lbs.Ability to work in an environment where chemicals are frequently used for cleaning where medical and electrical hazards may be present and where dust mist and steam are frequently generated in housekeeping tasks.Ability to work at a rapid pace and perform a variety of repetitive duties.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 Employment Type : Full-Time Experience: years Vacancy: 1