Clinical Review Specialist

7 days ago


Olathe, Kansas, United States Cottonwood Springs Full time
About the Role

Cottonwood Springs is a leading behavioral healthcare provider seeking a skilled Clinical Review Specialist to join our Utilization Review team. As a key member of our team, you will play a critical role in ensuring our patients receive the necessary treatment and support.

Key Responsibilities
  • Act as a liaison between managed care organizations and our facility's behavioral health clinical treatment team.
  • Conduct clinical reviews in accordance with certification requirements of insurance plans or other managed care organizations.
  • Monitor patient length of stay and conduct initial and concurrent reviews when indicated to provide clinical information needed to support medical necessity criteria for appropriate level of care.
  • Facilitate peer-to-peer reviews between our facility's treatment provider and the managed care physician.
  • Assist the Assessment Department with completion of the precertification process for admissions.
  • Provide ongoing support and training for staff on documentation requirements, admission and continued stay criteria, and medical necessity updates.
Requirements
  • Bachelor's degree in a related field.
  • CPR and CPI Certification within 30 days of employment.
  • Previous utilization review experience in a psychiatric healthcare facility is preferred.


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