Specialist, Utilization Review

Job Title: Utilization Review Specialist, RN Location: Highland Springs in Highland Hills, OH Schedule: Full Time, Day Shift Your experience matters At Highland Springs, we are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. Here, you're not just valued as an employee, but as a person. As a Utilization Review Specialist, RN 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 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. AUR Specialist who excels in this role 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 in a timely manner. Interfaces with managed care organizations, external reviews, and other payers. Communicates with physicians to schedule peer-to-peer reviews. Accurately reports denials. Why join us We believe that investing in our employees is the first step to providing excellent patient care. 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. What we're looking for 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 preferred. May be required to work flexible hours and overtime EEOC Statement Highland Springs LLC is an Equal Opportunity Employer. Highland Springs LLC 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