PHP Utilization Review Specialist: Access & Care

Socket.dev; Doylestown (Bucks County); On-site; USD 55,000 - 70,000; Full time

Benefits offered by this job

DailyPay

Paid training and supervision

403(b) Retirement Plan

Full-Time Benefits

Job summary

Lenape Valley Foundation is seeking a Utilization Review Specialist to bridge clinical care and insurance providers for our Partial Hospitalization Program. You will oversee authorizations, utilization review activities, outcome tracking, and care coordination to ensure timely access to medically necessary treatment.

The role operates Monday–Friday 8:30 am to 3:30 pm in Bucks County, PA, with a focus on reducing denials and improving program efficiency.

Qualifications

• Healthcare-related education preferred and relevant experience welcomed.
• Strong computer skills and experience with electronic health records (EHR).
• Excellent verbal and written communication abilities.

Responsibilities

• Manage insurance authorizations for PHP clients, including initial, concurrent, and continued-stay requests.
• Serve as primary contact with insurance companies and utilization management.
• Review clinical information and submit documentation supporting medical necessity.
• Monitor authorization deadlines, approvals, denials, and requests for additional information.
• Coordinate with treatment team on stays, discharge planning, and care transitions.
• Run PROMIS assessments daily and track program outcomes.

Skills

EHR experience

Verbal and written communication

Education

Bachelor’s degree in human services or related field

Job description

Lenape Valley Foundation is seeking a Utilization Review Specialist to bridge clinical care and insurance providers for our Partial Hospitalization Program. You will oversee authorizations, utilization review activities, outcome tracking, and care coordination to ensure timely access to medically necessary treatment.

The role operates Monday–Friday 8:30 am to 3:30 pm in Bucks County, PA, with a focus on reducing denials and improving program efficiency.