Care Continuum Utilization Specialist

Lancaster-Behavioral-Health-Hospital; Lancaster (Lancaster County); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Competitive compensation

Generous paid time off

Medical, dental, vision plans

Tuition reimbursement

401(k) with company match

Stock plan and discounted stock

Job summary

Lancaster Behavioral Health Hospital (LBHH) is a 126-bed inpatient psychiatric facility, jointly operated by Lancaster General Health/Penn Medicine and UHS. The Utilization Management Coordinator will work with the multidisciplinary team to secure timely authorizations, ensure thorough documentation, and manage payer expectations for patient care and treatment decisions.

1–3 years of Utilization Management experience is preferred, with RN or Social Work licensure preferred.

Qualifications

• Bachelor’s degree in psych-related field and/or equivalent combination of education and experience.
• Masters preferred.
• 1 to 3 years of Utilization Management experience preferred.

Responsibilities

• Perform timely daily clinical reviews with all payer types to secure authorization for continued treatment based on payer criteria.
• Collaborate with hospital operations to ensure timely documentation aligns with patient conditions.
• Educate and guide on level of care requirements and payer expectations for patient acuity and utilization.
• Ensure denials are followed up weekly with detailed documentation.
• Maintain up-to-date Midas documentation with sufficient detail to secure payment.

Skills

Utilization Management

Education

Bachelor’s degree in psych-related field

Master’s degree preferred

Job description

Lancaster Behavioral Health Hospital (LBHH) is a 126-bed inpatient psychiatric facility, jointly operated by Lancaster General Health/Penn Medicine and UHS. The Utilization Management Coordinator will work with the multidisciplinary team to secure timely authorizations, ensure thorough documentation, and manage payer expectations for patient care and treatment decisions.

1–3 years of Utilization Management experience is preferred, with RN or Social Work licensure preferred.