Demo

Utilization Review Specialist

River Place Behavioral Health
Laplace, LA Full Time
POSTED ON 4/3/2025
AVAILABLE BEFORE 6/2/2025

Come join our team as a Utilization Review Specialist at River Place Behavioral Health! If you are passionate and dedicated to making a difference in the lives of those in need through compassionate therapeutic practices while working in a team environment that supports learning and growth, this position is right for you!

River Place Behavioral Health Hospital, a service of Ochsner Health System, is an 82 bed state of the art hospital located in Laplace, Louisiana.

As a Utilization Review Specialist at River Place you will participate in the development and implementation of patients' treatment plan by:

  • Providing consultation and guidance regarding admissions and patient length of stay to a variety of payers.
  • Securing authorizations with insurance companies for inpatient treatment and continue to obtain authorizations through ongoing clinical reviews until patient discharges from treatment.
  • Evaluating the utilization operation for compliance with mandatory policies and procedures.
  • Reviewing clinical documentation from denied stays against criteria to determine if documentation is adequate for requested treatment.
  • Maintaining efficient, positive customer service attitude towards patients, their families and co-workers while being responsive to customer needs.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

  • Associate's degree in nursing (LPN or RN) required. Bachelor's or Master’s degree in social work, behavioral or mental health, nursing or other related health field preferred.
  • Two or more years' experience with the population of the facility and previous experience in utilization management preferred.

LICENSES/DESIGNATIONS/CERTIFICATIONS:

  • Current licensure as an LPN or RN with the state of LA; or current clinical professional license or certification, as required.

Education

Preferred
  • Masters or better
  • Bachelors or better

Licenses & Certifications

Preferred
  • Lic Prof Counselor
  • Reg Nurse
  • Lic Master's Social Wkr

Behaviors

Preferred
  • Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
  • Team Player: Works well as a member of a group
  • Dedicated: Devoted to a task or purpose with loyalty or integrity

Motivations

Preferred
  • Growth Opportunities: Inspired to perform well by the chance to take on more responsibility
  • Job Security: Inspired to perform well by the knowledge that your job is safe
  • Self-Starter: Inspired to perform without outside help
  • Goal Completion: Inspired to perform well by the completion of tasks
  • Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization

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