Specialist, Utilization Review

Your experience matters 
Copper Springs is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Utilization Review Specialist joining our team, you're embracing a vital mission dedicated to making communities healthier ®. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve.

How you'll contribute

A Utilization Review Specialist who excels in this role:

• Facilitate clinical reviews for all patient admissions and continued stays.
• Analyze patient records to determine the medical necessity and appropriateness of admissions, treatment, and length of stay.
• Collaborate with managed care organizations, external reviewers, and payers to support coverage determinations.
• Advocate for patients with substance use, dual diagnosis, psychiatric, or emotional disorders to ensure access to medically necessary treatment.
• Communicate with external case managers and payers to obtain and maintain insurance authorizations throughout the patient stay.
• Partner with the interdisciplinary treatment team to support care planning and ensure timely, appropriate utilization of services.
• Apply knowledge of clinical criteria and managed care requirements for inpatient and outpatient authorizations.
• Complete pre-certifications and re-certifications for inpatient and outpatient services.
• Communicate authorization updates, denials, and approvals to designated stakeholders in a timely manner.
• Actively collaborate with the interdisciplinary team to gather clinical information and provide authorization updates.
• Participate in treatment team meetings to ensure awareness of coverage status and gather information for payer communication.
• Work closely with the Director of Nursing (DON) to ensure documentation requirements are met.
• Prepare and submit thorough, timely appeals for denied services.
• Coordinate with physicians to schedule peer-to-peer reviews with payers.
• Accurately track and report denials, authorizations, and payer communications.

What we're looking for

Education:

• Bachelor's degree is required. Master's degree preferred.
   

Licenses/Certifications

• Current unencumbered clinical license is strongly preferred.
• CPR certification and Crisis Prevention Training (CPI) preferred.
   

Experience:

• Previous utilization review experience in a psychiatric healthcare facility preferred.

Other:

• May be required to work flexible hours and overtime
  
   

Schedule: Monday - Friday

Why join us

We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers: 

• Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Professional Development: Ongoing learning and career advancement opportunities.

More about Copper Springs 

Copper Springs is a behavioral health hospital located in Avondale, AZ, part of the greater Phoenix metro area. We provide inpatient and outpatient programming for those facing mental health and addiction challenges. Our programs offer caring, compassionate treatment for adolescents and adults, as well as specialized programming for active-duty military, veterans, first responders, and other high-risk frontline professionals.

Programs include inpatient mental health and addiction treatment, Partial Hospitalization Programs (PHP), Intensive Outpatient Programs (IOP), and Help for Heroes®.

EEOC Statement

Copper Springs is an Equal Opportunity Employer. Copper Springs is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.

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.