Behavioral Health Utilization Review Specialist (PHP)

Lenape Valley Foundation; Doylestown (Bucks County); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

DailyPay

Paid training

403(b) Retirement Plan

PTO 15 days + 10 sick + 4 personal + 7

Medical insurance

Dental insurance

Vision insurance

FSA

Long-Term Disability

Life Insurance

Employee Assistance Program

Continuing Education Assistance

Job summary

Lenape Valley Foundation is seeking a Utilization Review Specialist to support our Partial Hospitalization Program (PHP). This role bridges the clinical team and insurers, overseeing authorizations, utilization review activities, outcome tracking, and care coordination while helping patients access services.

Hours are Monday–Friday 8:30 am–3:30 pm. The position requires a Bachelor’s degree in human services or related field, strong verbal and written communication skills, and the ability to meet

Qualifications

• Bachelor’s degree in human services, Psychology, Social Work, Sociology, or related field preferred.
• Strong verbal and written communication skills.
• Ability to meet the physical demands of the role, with or without accommodation.

Responsibilities

• Manage insurance authorizations for PHP clients, including initial, concurrent, and continued-stay requests.
• Serve as the primary contact with insurance companies and utilization management departments.
• Review clinical information and submit documentation supporting medical necessity.
• Monitor authorization deadlines, approvals, denials, and requests for additional information.
• Coordinate with the treatment team on continued stays, discharge planning, and care transitions.
• Run daily PROMIS assessments and track program outcomes.
• Assist with referrals to outpatient services and community resources.
• Maintain accurate documentation and authorization records within the EHR.
• Help identify opportunities to reduce denials and improve program efficiency.
• Perform other duties as assigned.

Skills

Verbal and written communication

Education

Bachelor’s degree in human services or related field

Tools

EHR system

Job description

Lenape Valley Foundation is seeking a Utilization Review Specialist to support our Partial Hospitalization Program (PHP). This role bridges the clinical team and insurers, overseeing authorizations, utilization review activities, outcome tracking, and care coordination while helping patients access services.

Hours are Monday–Friday 8:30 am–3:30 pm. The position requires a Bachelor’s degree in human services or related field, strong verbal and written communication skills, and the ability to meet