We are looking for a detailed-oriented Utilization Review (UR) Specialist to help us maximize patient care quality and ensure seamless insurance operations. The UR Specialist evaluates patient medical records to ensure treatments meet clinical necessity and regulatory standards. You will serve as the primary bridge between our medical staff and insurance providers, facilitating timely care approvals and minimizing claim denials.Other responsibilities include retrieving discharge documents on a daily basis from charts, faxing when applicable, and retrieving authorizations. KEY RESPONSIBILITIES:Evaluate outpatient charts against established clinical criteria.Submit and track insurance authorization requests.Draft and submit clinical appeals for denied services.Communicate directly with insurance medical directors and case managers.Advise physicians and clinical staff on documentation requirements.Monitor utilization trends, denial rates, and approval timelines.Ensure adherence to Medicare, Medicaid, and private payer guidelines.Hours are Monday - Friday from 8:00am - 4:30pmRequirementsCurrent LPN, RN or other Clinical Licensure and/or master’s degree required.Minimum two (2) years of clinical experience, with 1+ years in utilization review or case management requiredKnowledge of Nevada Payors requiredPrevious experience working in behavioral healthcare strongly preferredStrong Microsoft word and excel skills requiredMaintains confidentiality of patients at all timesBenefitsEligible for benefits 1st of the month following one month of employment.Desert Parkway offers competitive benefits to include:Health insuranceVision insuranceDental insurance401K Retirement PlanHealthcare spending accountDependent care spending accountPTO Plan with holiday premium payDiscounted cafeteria meal planLife insurance (Supplemental Life, Term and Universal plans are also available)Short- and long-term disability (with additional buy-in opportunities)
We are looking for a detailed-oriented Utilization Review (UR) Specialist to help us maximize patient care quality and ensure seamless insurance operations.
The UR Specialist evaluates patient medical records to ensure treatments meet clinical necessity and regulatory standards. You will serve as the primary bridge between our medical staff and insurance providers, facilitating timely care approvals and minimizing claim denials.
Other responsibilities include retrieving discharge documents on a daily basis from charts, faxing when applicable, and retrieving authorizations.
KEY RESPONSIBILITIES:
- Evaluate outpatient charts against established clinical criteria.
- Submit and track insurance authorization requests.
- Draft and submit clinical appeals for denied services.
- Communicate directly with insurance medical directors and case managers.
- Advise physicians and clinical staff on documentation requirements.
- Monitor utilization trends, denial rates, and approval timelines.
- Ensure adherence to Medicare, Medicaid, and private payer guidelines.
- Hours are Monday - Friday from 8:00am - 4:30pm
Requirements
- Current LPN, RN or other Clinical Licensure and/or master’s degree required.
- Minimum two (2) years of clinical experience, with 1+ years in utilization review or case management required
- Knowledge of Nevada Payors required
- Previous experience working in behavioral healthcare strongly preferred
- Strong Microsoft word and excel skills required
- Maintains confidentiality of patients at all times
Benefits
Eligible for benefits 1st of the month following one month of employment.
Desert Parkway offers competitive benefits to include:
- Health insurance
- Vision insurance
- Dental insurance
- 401K Retirement Plan
- Healthcare spending account
- Dependent care spending account
- PTO Plan with holiday premium pay
- Discounted cafeteria meal plan
- Life insurance (Supplemental Life, Term and Universal plans are also available)
- Short- and long-term disability (with additional buy-in opportunities)
Desert Parkway Behavioral Healthcare Hospital is an acute psychiatric facility located in the center of Las Vegas, Nevada. Desert Parkway’s comprehensive mental health programs are designed to treat adolescent and adult patients with both dignity and respect while providing the very best in care.We are dedicated to helping patients in the Las Vegas area with behavioral illness and/or chemical dependency with compassion and kindness. Our mental health facilities offer a variety of psychiatric healthcare programs which include mental health services such as:
Assessments
Referrals
Inpatient psychiatric crisis stabilization
Las Vegas psychiatry and chemical dependency detox/rehab
Outpatient programs
We also offer our Hope for Heroes program which is geared towards helping veterans overcome service-related obstacles to their emotional and mental well-being. Through Hope for Heroes, we hope to help veterans discover a way to live a functional, fulfilling life.With our mental health programs, we strive to provide a safe and accepting environment for all of our patients. Our private facility currently has 152 patient beds and is staffed by qualified, experienced personnel who are dedicated to providing the highest level of care to each patient.At Desert Parkway Behavioral Healthcare Hospital, we are committed to delivering the best in psychiatric healthcare to our community through our mental health programs in Las Vegas, NV. This includes helping to educate patients, family members, and the community at large about mental health illnesses and addiction.
Desert Parkway Behavioral Healthcare Hospital is an acute psychiatric facility located in the center of Las Vegas, Nevada. Desert Parkway’s comprehensive mental health programs are designed to treat adolescent and adult patients with both dignity and respect while providing the very best in care.
We are dedicated to helping patients in the Las Vegas area with behavioral illness and/or chemical dependency with compassion and kindness. Our mental health facilities offer a variety of psychiatric healthcare programs which include mental health services such as:
We also offer our Hope for Heroes program which is geared towards helping veterans overcome service-related obstacles to their emotional and mental well-being. Through Hope for Heroes, we hope to help veterans discover a way to live a functional, fulfilling life.
With our mental health programs, we strive to provide a safe and accepting environment for all of our patients. Our private facility currently has 152 patient beds and is staffed by qualified, experienced personnel who are dedicated to providing the highest level of care to each patient.
At Desert Parkway Behavioral Healthcare Hospital, we are committed to delivering the best in psychiatric healthcare to our community through our mental health programs in Las Vegas, NV. This includes helping to educate patients, family members, and the community at large about mental health illnesses and addiction.
