Utilization Review Specialist

Job DescriptionYour experience mattersEl Dorado Springs Behavioral Health 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 contributeA Utilization Review Specialist who excels in this role:Facilitates clinical reviews for all patient admissions and continued stays.Analyzes patient records to determine the appropriateness 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 managed care providers to ensure access to necessary treatment.Contacts external case managers and managed care organizations to obtain certification of insurance benefits throughout the patient's stay and assists the treatment team in understanding requirements for continued stay and discharge planning.Demonstrates knowledge of clinical criteria and managed care requirements for inpatient and outpatient authorization, and advocates for coverage of necessary services.Completes pre-certifications and re-certifications for inpatient and outpatient services; reports denials and authorization information to the appropriate resource.Actively communicates with the interdisciplinary team to obtain pertinent information and provide updates on authorizations.Participates in treatment team meetings to ensure staff understand coverage and to gather information for communication with external agencies.Collaborates with the Director of Nursing (DON) to ensure documentation requirements are met.Ensures appeals are completed thoroughly and in a timely manner.Interfaces with managed care organizations, external reviewers, and other payers.Communicates with physicians to schedule peer-to-peer reviews.Accurately reports denials.About our TeamDriven by a mission to help individuals regain stability and wellness, our multidisciplinary team works collaboratively to provide compassionate care while fostering a supportive, safety-focused workplace culture for our staff and patients alike.What we're looking forApplicants must have a Bachelor's degree (required). Master's degree is preferred. Additional requirements include:Previous utilization review experience in a psychiatric healthcare facility preferred.Current unencumbered clinical license is strongly preferred.CPR certification and Crisis Prevention Training (CPI) preferred. May be required to work flexible hours and overtime.SchedulePRN (as needed)This position does not have a set weekly schedule. You'll be called in to work when extra help is needed—such as covering for someone, handling busy periods, or filling gaps in the schedule. Hours can vary from week to week, and there's no guaranteed hours.Why join usWe believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers: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.More about El Dorado SpringsEl Dorado Springs features a state-of-the-art facility with over 100 private and semi-private rooms, providing a secure and therapeutic setting focused on comfort, dignity, and healing. Patients receive 24/7 medically supervised care, evidence-based therapy, medication management, and comprehensive discharge and aftercare planning.Accredited by The Joint Commission and certified by CMS, El Dorado Springs Behavioral Health is committed to delivering relationship-centered, evidence-based care that improves outcomes and supports long-term recovery.The hospital offers a full continuum of care, including inpatient psychiatric stabilization, medically assisted detox (MAT), Partial Hospitalization Program (PHP), and Intensive Outpatient Program (IOP). These programs are designed to support individuals experiencing acute mental health symptoms, substance use disorders, or co-occurring conditions in a safe, structured environment.EEOC StatementEl Dorado Springs Behavioral Health is an Equal Opportunity Employer. El Dorado Springs Behavioral Health is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.