Utilization Review Specialist

Job Description

At Oakwood Springs, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities 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.

Essential Functions

• 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.
• Other duties as assigned.

What we offer

Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers:

• Comprehensive medical, dental, and vision plans, plus flexible-spending and health-savings accounts
• Competitive paid time off
• Income-protection programs, such as life, accident, critical-injury insurance, short- and long-term disability, and identity theft coverage
• Tuition reimbursement, loan assistance, and 401(k) matching
• Employee assistance program including mental, physical, and financial wellness
• Professional development and growth opportunities

Qualifications and requirements Education: Bachelor's degree required. Master's degree preferred. Experience: Previous utilization review experience in a psychiatric healthcare facility preferred. License: Current unencumbered clinical license strongly preferred. Additional Requirements: CPR certification and Crisis Prevention Training (CPI) preferred. May be required to work flexible hours and overtime.

About Us Oakwood Springs is a 72 - bed hospital located in Oklahoma City, OK, and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestoneyour experience matters.

EEOC Statement

Oakwood Springs is an Equal Opportunity Employer. Oakwood Springs is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.