Specialist, Utilization Review

Your experience matters. At Columbus Springs-East, we are committed to empowering and supporting a diverse workforce that can drive quality, scalability, and significant impact across our hospitals and communities. In this role, you will support staff who interface with and provide care to patients and community members, shaping a healthier future for the communities we serve. What We Offer Comprehensive medical, dental, and vision plans, plus flexible-spending and health‑savings accounts Competitive paid time off and extended illness bank package for full‑time employees 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 How You'll Contribute As a Utilization Review Specialist, you facilitate clinical reviews on all patient admissions and continued stays. You analyze patient records to determine the legitimacy of admission, treatment, and length of stay, and interface with managed care organizations, external reviewers, and other payers. You advocate on behalf of patients with substance abuse, dual diagnosis, psychiatric, or emotional disorders to managed care providers for necessary treatment, contact external case managers for insurance benefit certification, and assist the treatment team in understanding the insurance company’s requirements for continued stay and discharge planning. Qualifications And Requirements Bachelor’s degree required; Master’s degree preferred. Previous utilization review experience in a psychiatric healthcare facility preferred. Current unencumbered clinical license strongly preferred. CPR certification and Crisis Prevention Training (CPI) preferred. Essential Functions Apply clinical criteria and managed care requirements for inpatient and outpatient authorization and advocate on behalf of patients to secure coverage for needed services. Complete pre‑ and re‑certifications for inpatient and outpatient services, report appropriate denials, and provide authorization information to designated resources. Communicate actively with interdisciplinary teams to acquire pertinent information and provide updates on authorizations. Participate in treatment teams to ensure staff understand coverage and collect information for communication with agencies. Work with the Director of Nursing 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. Supervisory Responsibilities Manage the work of others, including planning, assigning, scheduling, and reviewing work. Ensure quality standards, and be responsible for hiring, terminating, training, developing, reviewing performance, and administering corrective action for staff. About Us Columbus Springs‑East is a 72‑bed hospital located in Columbus, OH, 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 milestone, your experience matters. EEOC Statement Columbus Springs‑East is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law. #J-18808-Ljbffr Lifepoint Health®