Job Title: Utilization Review Specialist 
Job Type: Onsite, Full-time

Pay rate: $52-$71

Work Schedule: Monday-Friday 8am-5pm MST

How you’ll contribute 

The responsibility of the Utilization Review Director is to ensure the utilization review activities are completed accurately and timely. This includes the precertification and recertification, peer to peer process, and appeals. The UR Director will report consistently and accurately to the CEO or delegate the authorization status of current patients and appeals. The Director will ensure that all UR staff members follow department and facility procedures. The Director will further ensure that communication with all relevant departments, but especially CBO and Business Office, meets staff and patient needs. The UR Director will report consistently and accurately to the CEO or delegate the authorization status of current patients and appeals

Other Duties Include: 

• Oversees the UR department, ensuring staff has completed all assignments and monitors performance.
• Ensures all pre-certifications are completed for inpatient and outpatient services.
• Ensures all re-certifications are completed for inpatient and outpatient services and reports status to the CEO or delegate.
• Assists with creation of treatment team agenda and participates to ensure team is aware of coverage info as well as collecting information for communication with insurance or other funding source.
• Be available to educate staff members from other relevant departments on documentation requirements / medical criteria and does so in a professional, organized, and understandable manner.
• 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.
• Participates in Administrator on call rotation
• Communicate with physicians to schedule peer to peer reviews.
• Accurately report denials.
• Is available to proctor staff members at other Springstone facilities on relevant policies and procedures. 

What we offer 

We offer an excellent total compensation package, including a competitive salary and benefits. Some of our benefits include 401k, PTO, medical, dental, vision, tuition reimbursement, and an Employee Assistance Program. 

Qualifications and requirements 

• Education: Bachelor's degree required. Associates degree preferred.
• Experience: Previous utilization review experience in a psychiatric healthcare facility preferred.
• License: Current unencumbered clinical license strongly preferred. RN license preferred. 
• Additional Requirements: CPI and CPR preferred within 30 days of hire. May be required to work flexible hours.