Lifepoint Health®
Utilization Review Specialist at Lifepoint Health®
Mercy Behavioral Health Hospital is operated jointly with Lifepoint Health and Mercy Health. We are driven by a profound commitment to prioritize your well‑being so you can provide exceptional care to others. By joining our team, you’re embracing our promise to provide superior patient care that exceeds industry standards as well as patient expectations. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve.
Schedule Full Time
How You’ll Contribute Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine the 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 patient’s stay and assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning.
Qualifications
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.
Participates 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.
Ensures appeals are completed thoroughly and on a timely basis.
Benefits
Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full‑time and part‑time employees.
Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short‑ and long‑term disability, paid family leave and paid time off.
Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
Employee Well‑being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
Professional Development: Ongoing learning and career advancement opportunities.
Brand New Facility: Opportunity to work in a brand‑new, state‑of‑the‑art hospital with cutting‑edge equipment and technology.
What We’re Looking For
Education: Bachelor’s degree required. Master’s degree preferred.
Experience: Previous utilization review experience in a psychiatric healthcare facility preferred.
License: Current unencumbered clinical license strongly preferred.
Additional Requirements: CPR certification and Crisis Prevention Training (CPI) preferred. May be required to work flexible hours and overtime.
EEOC Statement Mercy Behavioral Health Hospital is an Equal Opportunity Employer. Mercy Behavioral Health Hospital is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.
Seniority Level
Entry level
Employment Type
Full‑time
Job Function
Other
Hospitals and Health Care
Location: Hermitage, PA
Referrals increase your chances of interviewing at Lifepoint Health® by 2x.
#J-18808-Ljbffr
Schedule Full Time
How You’ll Contribute Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine the 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 patient’s stay and assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning.
Qualifications
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.
Participates 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.
Ensures appeals are completed thoroughly and on a timely basis.
Benefits
Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full‑time and part‑time employees.
Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short‑ and long‑term disability, paid family leave and paid time off.
Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
Employee Well‑being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
Professional Development: Ongoing learning and career advancement opportunities.
Brand New Facility: Opportunity to work in a brand‑new, state‑of‑the‑art hospital with cutting‑edge equipment and technology.
What We’re Looking For
Education: Bachelor’s degree required. Master’s degree preferred.
Experience: Previous utilization review experience in a psychiatric healthcare facility preferred.
License: Current unencumbered clinical license strongly preferred.
Additional Requirements: CPR certification and Crisis Prevention Training (CPI) preferred. May be required to work flexible hours and overtime.
EEOC Statement Mercy Behavioral Health Hospital is an Equal Opportunity Employer. Mercy Behavioral Health Hospital is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.
Seniority Level
Entry level
Employment Type
Full‑time
Job Function
Other
Hospitals and Health Care
Location: Hermitage, PA
Referrals increase your chances of interviewing at Lifepoint Health® by 2x.
#J-18808-Ljbffr