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Utilization Review Specialist
4 months ago
Overview:
**Copper Springs East **is a 72-bed behavioral hospital located near Gilbert, AZ. The hospital offers inpatient and outpatient mental health and addiction treatment to adults, adolescents and their families. At **Copper** **Springs East** we are dedicated to **Changing People’s Lives®**.
The Utilization Review department plays an essential role in helping fulfill our mission of “**Changing People’s Lives®”.** Utilization Review team members advocate on behalf of our patients to managed care providers for necessary treatment. As a Utilization Review Specialist, you will accurately and timely complete utilization review activities.
**Members of our team enjoy**:
- Working with a highly engaged staff
- Healthy staffing levels
- Flexible scheduling
- Career growth
- Competitive compensation- UKG Wallet - We’ve partnered with UKG Wallet, a voluntary Earned Wage Access benefit, to offer employees access to their pay on their schedule.
Position Details:
- Acts as a liaison between managed care organizations and the facility’s behavioral health clinical treatment team.
- Conducts clinical reviews in accordance with certification requirements of insurance plans or other managed care organizations.
- Monitors patient length of stay and conducts initial and concurrent reviews when indicated to provide clinical information needed to support medical necessity criteria for appropriate level of care.
- Facilitates peer to peer reviews between the facility treatment provider and the managed care physician.
- Assists the Assessment Department with completion of the pre-certification process for admissions.
- Provides ongoing support and training for staff on documentation requirements, admission and continued stay criteria, and medical necessity updates.
Qualifications:
**Qualifications**:
- Knowledge of mental health and chemical dependency terminology, symptoms, diagnoses, and treatment.
- Ability to communicate effectively with patients, internal and external treatment providers, and managed care clinical review care managers.
- Ability to multi-task, pay attention to detail, problem solve, utilize critical thinking skills, prioritize, and work both independently and as a part of a team.
- Strong computer skills and ability to navigate electronic systems applicable to job functions.
**Requirements**:
- Bachelor’s degree or current clinical license required in lieu of degree
- CPR and CPI Certification within 30 days of employment
**Experience**:
- Previous utilization review experience in a psychiatric healthcare facility preferred
Education and experience in the field(s) of: Social Work, Psychology, Psychiatric Nursing, Marriage and Family and Child Counseling, Chemical Dependency Counseling, Registered Nursing or a closely related science field
