Utilization Review Specialist

LifePoint Health

  • Tampa, FL
  • Permanent
  • Full-time
  • 7 hours ago
Job Category: Revenue Cycle ManagementDegree Level: Bachelor's DegreeJob Description:Utilization Review SpecialistYour experience matters:At Tampa General Rehab, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities 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.Additional responsibilities include:
  • 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
  • Complete 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.
  • Interface with managed care organizations, external reviews, and other payers.
  • Communicate with physicians to schedule peer-to-peer reviews.
What we offer:Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers:
  • 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
Qualifications and requirements:
  • Bachelor's degree required. Master's degree preferred.
  • Experience: Previous utilization review experience in a psychiatric healthcare facility preferred.
  • Additional Requirements: CPR certification and Crisis Prevention Training (CPI) preferred.
  • May be required to work flexible hours and overtime
EEOC StatementTampa General Rehabilitation is an Equal Opportunity Employer. Tampa General Rehabilitation is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.About Us: Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.About the Team: We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.

LifePoint Health