Utilization Review Specialist

About the role

Sycomore Springs is a 48-bed hospital located in Layfette, IN, part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier.

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.
• Affords advocacy 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 and 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.
• 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.
• Interacts with managed care organizations, external reviews, and other payers.
• Communicates with physicians to schedule peer to peer reviews.
• Accurately reports denials.

Qualifications

• Bachelor's Degree
• Previous utilization review experience in a psychiatric healthcare facility preferred.

Benefits

• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees
• Competitive Paid Time Off
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Tuition Reimbursement/Assistance for qualified applicants
• And much more...

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/Assistance for qualified applicants
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Competitive Paid Time Off
• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/Assistance for qualified applicants
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Competitive Paid Time Off
• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/Assistance for qualified applicants
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Competitive Paid Time Off
• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/Assistance for qualified applicants
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Competitive Paid Time Off
• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/Assistance for qualified applicants
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Competitive Paid Time Off
• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/Assistance for qualified applicants
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Competitive Paid Time Off
• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/Assistance for qualified applicants
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Competitive Paid Time Off
• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/Assistance for qualified applicants
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Competitive Paid Time Off
• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/Assistance for qualified applicants
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Competitive Paid Time Off
• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/Assistance for qualified applicants
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Competitive Paid Time Off
• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/Assistance for qualified applicants
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Competitive Paid Time Off
• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/Assistance for qualified applicants
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Competitive Paid Time Off
• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/Assistance for qualified applicants
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Competitive Paid Time Off
• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/Assistance for qualified applicants
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Competitive Paid Time Off
• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/Assistance for qualified applicants
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Competitive Paid Time Off
• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/Assistance for qualified applicants
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Competitive Paid Time Off
• Health (Medical, Dental, Vision)
• 401K Benefits for full-time employees

Pay

Commensurate with experience.

Schedule

N/A

Skills

N/A

Benefits

• Tuition Reimbursement/