Learn more about Hansei’s Utilization Review team and their impact on medical and mental healthcare.
Utilization review (UR), by definition, is used by healthcare organizations, insurance companies, and other stakeholders to evaluate the necessity, appropriateness, and efficiency of medical services provided to patients. The goal of UR is to ensure that patients receive high-quality care, while minimizing unnecessary costs.
If you ask Lauren Jensen, Hansei’s Director of UR, utilization review is the process of coordinating the use of insurance benefits for clients seeking treatment for life-saving medical and mental health services.
“Here at Hansei, we advocate for clients to be able to get the help they need, while maximizing the use of their insurance benefits to minimize financial impact on the client. This enables clients to focus on the treatment they need, rather than worry about how they will afford the necessary treatment.”
Why is Utilization Review Beneficial?Utilization review is beneficial and plays a crucial role in ensuring that patients receive appropriate, high-quality care while managing costs, promoting efficiency, and enhancing patient safety.
Lauren and her team work closely together to identify payor trends in an effort to navigate challenges with authorization denials and benefit limitations.
“Because I have such a strong team, I am able to focus so much of my attention on our customers. The UR team here at Hansei is the most committed team I have had the pleasure to lead- committed to our customers, committed to each other with teamwork, committed to helping people get the treatment they deserve, and committed to Hansei’s mission and core values.”
Find out what Lauren’s team thinks about the work they do with Hansei.
Lauren’s UR team consists of 40 UR coordinators, 1 clinical documentation analyst, 2 peer review licensed clinicians, and 3 UR team leads. She works alongside her team – with daily tasks that include auditing clinical documentation, providing medical necessity training to Hansei customers, investigating denial trends, providing guidance to her team to help navigate insurance obstacles, and offering support to other Hansei departments to help them better understand the UR workflow.
“To date, we have worked to drastically increase overall length of stay and reduce denial rates, which in turn, has helped our customers provide life-saving treatment to clients all over the country.”
“I was immediately interested in Hansei to further client advocation from behind the scenes and continue growing my knowledge.”
“To me UR is fighting for our patients behind the scenes to get the most adequate care and longest length of stay as possible. I believe that UR plays a vital role in making sure patients are set up for success once they discharge.”
“Evidence suggests that longer treatment episodes result in better long-term outcomes, and it’s a privilege to get the opportunity to give our all and support those who may be at a vulnerable time in their lives.”
“I feel here at Hansei, there are a lot of opportunities for me to grow in my role and further my knowledge in UR and progress my career. I feel very blessed to have landed with the Hansei Family!”
“To know that I was a part of someone taking a step toward life is what helps me sleep at night.”
“I am proud to work for Hansei and grateful they gave me this opportunity.”
Emily: Before I worked at Hansei, I worked in Admissions where I was on call 24/7, while working in direct client care. I truly enjoyed being in the role of helping others in the door, but I wanted to take a different route with my career. I was most interested in learning about the other side of client care in Utilization Review while still being able to advocate.
Sarah: There are a lot of elements appealing to me about my role with Hansei. I felt I would be a great fit within the company culture. I wanted to work with a progressive team and the collaboration of this company suits me and my experience and I was looking for the opportunity to get involved more with Utilization Review, which directly links to my previous roles where I had extended experience in UR.
Heather: My best friend worked here and spoke very highly of the team and process of being a UR specialist. As a recovering addict, I always wanted to do something that helped other addicts but did not want to work directly in a treatment center due to the hours and having a family at home.
Deana: I would have to say what interested me the most about Hansei, at first, was word of mouth. After I started working with Hansei I found that leadership, training, support, and overall atmosphere of the company was like nothing I had with previous employers.
Jessica: I am currently one of Hansei’s three Utilization Review Team leads, and I oversee 15 direct UR specialists. I still carry a small caseload as well, and I manage a few facilities. I work very closely with Emily Roy in strategizing through different situations and working to provide the whole team with added support and resources.
Emily: I am currently one of Hansei’s Team Leads, overseeing 13 UR specialists on my team! I also manage a small caseload with 5 facilities total. The day-to-day definitely varies – I am consistently communicating with Jessica, one of my fellow leads, and the UR specialists on the team. Jessica and I work collectively to help others by answering questions, offering support/assistance where it is needed, training, and being as available as possible to offer any knowledge we have! We also spend a great deal of time auditing, organizing, and creating/coordinating team training!
Sarah: I get up stress free because we get to work from home, which makes the mornings more peaceful. I tend to go through my morning emails and voicemails from the day before, and then begin to work on my CCR’s and new admits. Then, I end my day reviewing everything I did that day to make sure my trackers, census, and EMR are updated and accurate as can be.
Heather: My day-to-day consists of using every resource available to help our clients stay covered and get through some of their hardest days without having to worry about the financial part of being in treatment!
Jessica: I work and communicate with our partners and a multitude of payors on a regular basis! Being in the lead role and still having a caseload puts me in the middle of each!
Sarah: I’d say a few times a day – give or take a few. I’m a self-starter, who applies individual initiative to get the job done and communicate with my facilities and payors everyday whether it’s through phone calls, emails, voicemail, teams, or using a portal.
Deana: I currently am in communication with payors multiple times a day either through live phone calls, faxes, or voicemail.
Jessica: I enjoy both direct UR and being in a lead position, but I enjoy the lead position the most. The reason for this is that it is super important to me that our team be supported and have everything they need to be able to effectively do their jobs. Emily and I are readily available to the team for any issues, problem solving, or just any general support needed!
Emily: My favorite parts about this job are: 1) being able to help others, and 2) the people that I work with. Hands down, witnessing the teamwork is inspiring. As a lead, I love the ability to help people both on the Hansei team, as well as the clients who seek help coming into the facilities we work with.
Sarah: I take pride in my work. I want the patients to get the best care they deserve and to be authorized to get the care they need. I want to see them succeed in life after treatment. I really enjoy the fact that I know I genuinely help change lives, not just help them. I also enjoy the freedom I have working from home and not feeling a bit stressed out and driving to and from an office dealing with traffic every day.
Heather: Advocating for those in need, as a special needs mom this has been a huge struggle in my life for the past 15 years and this job serves such a great purpose.
Skylar: Working in the UR department at Hansei is incredibly enjoyable and rewarding. I greatly appreciate the opportunity to advocate for clients seeking mental health or substance abuse services.
Jessica: The hardest part would have to be the ever-changing world of medical necessity and insurance seems to live by whatever criteria they feel like – even when it makes no sense. We continue to adapt to these changes!
Emily: Insurance is always changing, and we must adapt with those changes – this can sometimes be a learning curve. Denials are always a difficult part when it comes to UR knowing how it will impact the client, and the facility. As someone with an empathetic heart, this can be extremely hard!
Sarah: Getting denied when you know someone meets criteria. Also, retros are hard because they always have so many, and they are tedious. But I am here to paint the picture for the insurance companies and get our patients the care they truly deserve!
Heather: The hardest part will always be the denials when you know the client still needs more treatment and you have the supporting clinical to prove that. But even on those hard days this is the most rewarding job I have ever had and the most amazing group of people to work with!
Deana: The hardest part of this position, to me, would be receiving denials when you know the client is meeting for the requested level of care, but that is where I do enjoy a good peer review.
Jessica: I have been with Hansei, in the UR department, since pre-work from home days. Our team was small, there were like 6 of us. It’s been so amazing to see the growth, not just in the size of our team, but every process we use as well. We have come so far from paper charts, and all sharing every case, to where we are now!
Emily: I am coming up on my 5th year Anniversary with Hansei in March (queue the tears of joy). I have never worked for a more supportive company and team in all aspects. I, along with Jessica, remember the team when it was a small group of URs in one room – now look at where we are!
Skylar: Through the supportive leadership at Hansei, we are given all of the tools that we need to succeed in what we do.
At Hansei, the utilization review team works hard to provide UR services that assess medical necessity, appropriateness, and efficiency in healthcare and mental health services. Lauren, Jessica, Emily, and the entire UR team ensures that quality and cost standards are met, and that clients receive the highest quality of care and coverage they deserve.
To learn more about Hansei’s Utilization Review services, click here.