Lifepoint Health®
Overview
Job Title: Utilization Review Specialist Job Type: Full-time, Monday-Friday 7am-4pm MST (Onsite) Base pay range: $30.00/hr - $37.00/hr Wage scale: $30-37/hr This range is provided by Lifepoint Health®. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Responsibilities
Facilitates clinical reviews on all patient admissions and continued stays. Analyzes patient records to determine legitimacy of admission, treatment, and length of stay and interfaces with managed care organizations, external reviewers and other payers. Advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to manage care providers for necessary treatment. Contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient\'s stay and assists the treatment team in understanding the insurance company\'s requirements for continued stay and discharge planning. Display knowledge of clinical criteria, manage care requirements for inpatient and outpatient authorization and advocate on behalf of the patient to secure coverage for needed services. Complete pre and re-certifications for inpatient and outpatient services. Report appropriate denial, and authorization information to designated resource. Actively communicate with an interdisciplinary team to acquire pertinent information and give updates on authorizations. Work with the DON to ensure documentation requirements are met. Answer telephone calls appropriate to department guidelines and avoid excessive transfers. Interface with managed care organizations, external reviews, and other payers. Accurately report denials. Qualifications And Requirements
Bachelor\'s degree required Master\'s degree preferred 5-10 years of utilization review experience in a psychiatric healthcare facility preferred Current unencumbered clinical license strongly preferred CPR certification and Crisis Prevention Training (CPI) preferred. May be required to work flexible hours and overtime. About Us
Denver Springs located in Englewood, CO 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 milestone — your experience matters. EEOC Statement
Denver Springs is an Equal Opportunity Employer. Denver Springs is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment. 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 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.
#J-18808-Ljbffr
Job Title: Utilization Review Specialist Job Type: Full-time, Monday-Friday 7am-4pm MST (Onsite) Base pay range: $30.00/hr - $37.00/hr Wage scale: $30-37/hr This range is provided by Lifepoint Health®. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Responsibilities
Facilitates clinical reviews on all patient admissions and continued stays. Analyzes patient records to determine legitimacy of admission, treatment, and length of stay and interfaces with managed care organizations, external reviewers and other payers. Advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to manage care providers for necessary treatment. Contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient\'s stay and assists the treatment team in understanding the insurance company\'s requirements for continued stay and discharge planning. Display knowledge of clinical criteria, manage care requirements for inpatient and outpatient authorization and advocate on behalf of the patient to secure coverage for needed services. Complete pre and re-certifications for inpatient and outpatient services. Report appropriate denial, and authorization information to designated resource. Actively communicate with an interdisciplinary team to acquire pertinent information and give updates on authorizations. Work with the DON to ensure documentation requirements are met. Answer telephone calls appropriate to department guidelines and avoid excessive transfers. Interface with managed care organizations, external reviews, and other payers. Accurately report denials. Qualifications And Requirements
Bachelor\'s degree required Master\'s degree preferred 5-10 years of utilization review experience in a psychiatric healthcare facility preferred Current unencumbered clinical license strongly preferred CPR certification and Crisis Prevention Training (CPI) preferred. May be required to work flexible hours and overtime. About Us
Denver Springs located in Englewood, CO 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 milestone — your experience matters. EEOC Statement
Denver Springs is an Equal Opportunity Employer. Denver Springs is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment. 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 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.
#J-18808-Ljbffr