Utilization Review Specialist

Your Experience Matters

At Rock Springs, we put your well-being first-because when you're taken care of, you can take even better care of others. Here, you're not just valued as an employee, but as a person. As a member of 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.
Rock Springs is a 96-bed behavioral health hospital located in Georgetown, Texas, and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier® with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone-your experience matters.

Job Summary

The Utilization Review (UR) Specialist plays a critical role in advocating for patients by ensuring clinical reviews are conducted for all admissions and continued stays. This position interfaces with managed care organizations and insurance providers to secure necessary authorizations, while supporting treatment teams with guidance on payer requirements, discharge planning, and appeals.

Responsibilities

• Review patient records to determine medical necessity and appropriateness of admission, treatment, and continued stay
• Complete initial and ongoing certifications for inpatient and outpatient services
• Contact insurance companies and external case managers for benefit verification and authorization
• Participate in interdisciplinary treatment team meetings and communicate payer updates
• Ensure appeals and denials are processed promptly and thoroughly
• Collaborate with physicians for peer-to-peer reviews as needed
• Ensure clinical documentation aligns with payer requirements
• Communicate effectively with all stakeholders and maintain accurate records of authorization activity

Qualifications

• Education: Bachelor's degree required; Master's preferred
• Experience: Prior experience in utilization review, particularly in behavioral health or psychiatric settings, preferred
• License: Active, unencumbered clinical license strongly preferred
• Certifications: CPR and CPI preferred (required within 30 days of hire)

Physical, Mental & Special Demands

• Ability to sit, stand, walk, kneel, bend, and twist for extended periods
• Ability to lift/carry up to 20-50 lbs occasionally
• Ability to push/pull carts up to 100 lbs
• Visual acuity to read charts, screens, and printed materials
• Must function effectively in an environment with cleaning agents, medical hazards, and fluctuating pace

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.