PHP UTILIZATION REVIEW COORDINATOR

Northspringleesburg; Virginia (MN); On-site; USD 50,000 - 80,000; Full time

Job summary

Join a forward-thinking healthcare organization as a PHP Utilization Review Coordinator. In this pivotal role, you will ensure that patients receive appropriate care by conducting clinical reviews and coordinating discharge planning. Your expertise will bridge communication between clinical staff and insurance companies, ensuring that all documentation meets necessary standards. This position offers a competitive salary and a comprehensive benefits package, including health insurance and a 401(k) plan. If you are passionate about making a difference in the lives of adolescents in a supportive environment, this opportunity is perfect for you.

Benefits

Competitive Salary

Health Insurance

Paid Time Off

401(k) with Company Match

Qualifications

• Strong verbal and written communication skills required.
• Experience in healthcare settings preferred.

Responsibilities

• Conduct clinical reviews over the phone for admission appropriateness.
• Coordinate discharge planning with treatment teams and Social Workers.

Skills

Verbal Communication

Written Communication

Healthcare Experience

Insurance Billing Knowledge

Education

Master’s Degree in Human Services

Registered Nurse License

Job description

Responsibilities

Join Our Team as a PHP Utilization Review Coordinator!

North Spring Behavioral Healthcare is seeking a full-time PHP Utilization Review Coordinator to support our Partial Hospitalization and Outpatient programs.

What We Offer:

• Competitive Salary
• Comprehensive Benefits Package:
• Health insurance – Available after 30 days
• Paid Time Off – Start earning after 90 days
• 401(k) with company match – Eligible after 30 days

Role Overview:

The PHP Utilization Review Coordinator assists in screening patients at the pre-hospital level to ensure admission criteria are met. Upon admission, they review documentation to ensure it reflects and meets criteria for admission, continued stay, and discharge. They communicate with clinical staff, Business Office, Admissions, Medical Records, third-party reviewers, and hospital administration to facilitate appropriate hospital care.

Key Responsibilities:

• Conduct clinical reviews over the phone, evaluating charts for admission, stay, discharge appropriateness, and identifying high-risk cases.
• Coordinate discharge planning with treatment teams and Social Workers, monitoring patient outcomes.
• Participate in treatment team meetings, acting as a liaison and patient advocate with insurance companies.
• Alert the Director of Outpatient Services about potential review issues or denials and assist with appeals.
• Monitor clinical documentation, report issues to supervisors or the Director of Outpatient Services.
• Assist in screening patients pre-hospitalization to meet admission criteria.

About North Spring Behavioral Healthcare:

North Spring, a subsidiary of Universal Health Services, is a licensed and Joint Commission-approved 87-bed Psychiatric Residential Treatment Facility and a 40-bed Inpatient Acute Psychiatric Hospital located on 42 acres in Leesburg, VA. We provide therapeutic programs for adolescents in a safe environment that promotes growth and responsibility.

About Universal Health Services:

UHS is a leading healthcare management company operating hospitals, behavioral health facilities, and outpatient centers across the U.S. and abroad, with a focus on quality and compassionate care.

EEO Statement:

UHS is committed to equal employment opportunities and a respectful workplace, supporting diversity and inclusion in all employment practices.

Important Notice:

Beware of recruitment scams. UHS recruiters will never ask for financial or personal information via email or unsolicited calls. Verify job postings through official UHS websites.

Qualifications:

• Strong verbal and written communication skills; ability to rotate shifts and maintain confidentiality.
• Education: Master’s Degree in Human Services or a Registered Nurse License.
• Experience in healthcare settings, with knowledge of insurance billing and regulations; experience with children and adolescents in psychiatric or rehabilitation settings preferred.
• Physical ability to lift up to 50 pounds, stand, walk, kneel, reach, and perform CPR/First Aid.