Sandstone Healthcare Group
Sandstone Healthcare Group -
Are you experienced in psychiatric care and passionate about ensuring patients receive the right level of care at the right time? We are seeking a dedicated Utilization Review (UR) Specialist to join our team and support our mission of delivering quality behavioral health services.
What You'll Do
* Conduct utilization reviews to determine medical necessity and appropriate levels of care for psychiatric and behavioral health patients.
* Collaborate with physicians, nurses, and treatment teams to develop individualized care plans that align with payer requirements.
* Communicate with insurance companies, providing clinical documentation and justifications to support ongoing care.
* Monitor patient progress and identify opportunities for earlier discharge or transitions to alternative levels of care.
* Maintain accurate and timely documentation in compliance with state, federal, and organizational standards.
* Serve as a resource for clinical teams regarding payer guidelines, authorizations, and managed care processes.
What You'll Bring
* Required: Experience working in psychiatric, behavioral health, or mental health settings.
* Strong knowledge of managed care, payer guidelines, and utilization management processes.
* Excellent clinical assessment, critical thinking, and communication skills.
* Ability to collaborate across interdisciplinary teams and interact with external stakeholders.
* Nursing license (RN, LPN) preferred, but candidates with strong behavioral health utilization review experience will also be considered.
Why Join Us?
* Be part of a mission-driven organization focused on patient-centered care.
* Work alongside a supportive and collaborative clinical team.
* Competitive pay and comprehensive benefits package.
* Opportunities for growth in a growing behavioral health network.
Are you experienced in psychiatric care and passionate about ensuring patients receive the right level of care at the right time? We are seeking a dedicated Utilization Review (UR) Specialist to join our team and support our mission of delivering quality behavioral health services.
What You'll Do
* Conduct utilization reviews to determine medical necessity and appropriate levels of care for psychiatric and behavioral health patients.
* Collaborate with physicians, nurses, and treatment teams to develop individualized care plans that align with payer requirements.
* Communicate with insurance companies, providing clinical documentation and justifications to support ongoing care.
* Monitor patient progress and identify opportunities for earlier discharge or transitions to alternative levels of care.
* Maintain accurate and timely documentation in compliance with state, federal, and organizational standards.
* Serve as a resource for clinical teams regarding payer guidelines, authorizations, and managed care processes.
What You'll Bring
* Required: Experience working in psychiatric, behavioral health, or mental health settings.
* Strong knowledge of managed care, payer guidelines, and utilization management processes.
* Excellent clinical assessment, critical thinking, and communication skills.
* Ability to collaborate across interdisciplinary teams and interact with external stakeholders.
* Nursing license (RN, LPN) preferred, but candidates with strong behavioral health utilization review experience will also be considered.
Why Join Us?
* Be part of a mission-driven organization focused on patient-centered care.
* Work alongside a supportive and collaborative clinical team.
* Competitive pay and comprehensive benefits package.
* Opportunities for growth in a growing behavioral health network.