Utilization Review Specialist

Lifepoint Health • Englewood, CO

1d • $26 - $33

About The Position

Your experience matters Denver Springs is part of Lifepoint Health , a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Utilization Review Specialist joining our team, you’re embracing a vital mission dedicated to making communities healthier ® . Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve. How you’ll contribute Utilization 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 patient’s stay and assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning. A Utilization Review Specialist who excels in this role: 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. 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.

Requirements

• 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
• 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
• Bachelors required

Nice To Haves

• Masters preferred

Responsibilities

• Facilitates clinical reviews on all patient admissions and continued stays
• Analyzes patient records to determine legitimacy of admission, treatment, and length of stay
• 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 managed care providers for necessary treatment
• Contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient’s stay
• Assists the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning
• 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
• 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

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees