Utilization Review Specialist

Utilization Review Specialist 

Your experience matters:

At Wellbridge 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

Wellbridge Fort Worth is a full-service behavioral health hospital for adults and seniors. By prioritizing the dignity of our patients, individualized treatment, and holistic mind-body care, the dedicated professionals of Wellbridge are changing the way people think about mental illness and mental healthcare. It is our mission to improve the lives of our patients, families and each other.

Patients admitted to the Wellbridge Fort Worth Inpatient Mental Health program receive 24-hour supervised psychiatric treatment and crisis support for mental health issues. Emphasis is on identifying safety risks and needs, stabilizing crisis symptoms, increasing mental health knowledge, aiding the development of symptom management skills and establishing connections with aftercare services to support stability and ongoing treatment.

Wellbridge Fort Worth is a 48-bed inpatient psychiatric hospital providing full-service inpatient and outpatient treatment.