Behavioral Health Utilization Review Coordinator - PRN

Universal Health Services; Lawrenceville (GA); On-site; USD 52,000 - 73,000; Part time

Job summary

SummitRidge Hospital in Lawrenceville, GA is seeking a PRN Utilization Review Coordinator to support our behavioral health facility. This role coordinates utilization review activities, supports timely insurance authorization processes, and ensures compliance with payer requirements.

The ideal candidate will have strong communication skills, attention to detail, and experience in behavioral health or utilization management, with the ability to work independently in a fast-paced environment.

Qualifications

• High school diploma or equivalent; associate's or bachelor’s degree preferred.
• Experience in utilization review, case management, behavioral health or related healthcare.
• Knowledge of insurance authorization processes, payer requirements and medical necessity criteria.
• Strong organizational, communication and problem-solving skills.
• Ability to work independently and stay professional in a fast-paced setting.
• Proficiency with computer systems and electronic documentation.
• Familiar with utilization negotiations.

Responsibilities

• Conduct utilization review functions for assigned patients per policy and payer guidelines.
• Obtain, track, and maintain insurance authorizations and discharge planning updates.
• Communicate with insurance companies, clinical staff, and care team members.
• Ensure documentation is accurate and compliant with regulatory and payer standards.
• Support patient care updates related to level of care and medical necessity.
• Assist with appeals, denials, and other utilization management processes.
• Maintain confidentiality and HIPAA/privacy standards.

Skills

Strong communication

Attention to detail

Utilization management experience

Proficiency with computer systems

Independence and professionalism

Insurance authorization knowledge

Education

High school diploma or equivalent

Associate's or Bachelor's degree preferred

Job description

SummitRidge Hospital in Lawrenceville, GA is seeking a PRN Utilization Review Coordinator to support our behavioral health facility. This role coordinates utilization review activities, supports timely insurance authorization processes, and ensures compliance with payer requirements.

The ideal candidate will have strong communication skills, attention to detail, and experience in behavioral health or utilization management, with the ability to work independently in a fast-paced environment.