Utilization Review Specialist

How You'll Contribute 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 Team Driven 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 For Applicants must have a Bachelor's degree (required). Master's degree is preferred. 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. Schedule PRN (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 us 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. EEOC Statement El 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. #J-18808-Ljbffr