Utilization Review Specialist

Job Title

Utilization Review Specialist

Job Description

Mercy Behavioral Health Hospital is operated jointly with Lifepoint Health and Mercy Health. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. By joining our team, you're embracing our promise to provide superior patient care that exceeds industry standards as well as patient expectations. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve.

Mercy Behavioral Health is a joint venture owned and operated by Mercy Health and Lifepoint Health. With two of the most prominent names in healthcare joining forces, we are confidently executing the opening of a new hospital with seasoned professionals and plentiful resources. We take pride in being a place employees want to work, as well as eagerly pursue quality outcomes for patients and families alike.

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.

A UR 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.
• 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.

Why join us

We 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.
• Brand New Facility: Opportunity to work in a brand-new, state of the art hospital with cutting edge equipment and technology.

What we're looking for

Applicants should possess:

• 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.

EEOC Statement

Mercy Behavioral Health Hospital is an Equal Opportunity Employer. Mercy Behavioral Health Hospital is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.