PRN Behavioral Health Utilization Review Specialist

Universal Health Services; Lawrenceville (GA); On-site; USD 34,000 - 52,000; Full time

Job summary

SummitRidge Hospital in Lawrenceville, GA, part of Universal Health Services (UHS), is seeking a PRN Utilization Review Coordinator to support behavioral health services on an as-needed basis. You will coordinate utilization review activities, secure timely insurance authorizations, and ensure compliance with payer requirements.

Ideal candidates bring experience in behavioral health or utilization management, strong communication skills, and meticulous attention to detail in a fast-paced

Qualifications

• High school diploma or equivalent required; associate’s or bachelor’s degree preferred.
• Previous experience in utilization review, case management, behavioral health, or a related healthcare setting preferred.
• Knowledge of insurance authorization processes, payer requirements, and medical necessity criteria.
• Strong organizational, communication, and problem-solving skills.
• Ability to work independently and maintain professionalism in a fast-paced environment.
• Proficiency with computer systems and electronic documentation.
• Previous experience with third party payors.
• Must be familiar with utilization negotiations.

Responsibilities

• Conduct utilization review functions for assigned patients in accordance with facility policies and payer guidelines.
• Obtain, track, and maintain insurance authorizations, continued stay reviews, and discharge planning updates.
• Communicate effectively with insurance companies, clinical staff, and other care team members.
• Ensure documentation is accurate, timely, and compliant with regulatory and payer standards.
• Support coordination of patient care updates related to level of care and medical necessity.
• Assist with appeals, denials, and other utilization management processes as needed.
• Maintain confidentiality and adhere to all HIPAA and facility privacy standards.

Skills

Utilization review

Case management

Behavioral health

Insurance authorization processes

Payer requirements

Medical necessity criteria

Organizational skills

Communication skills

Problem-solving

Computer systems

Electronic documentation

Third-party payors

Utilization negotiations

Education

Associate or Bachelor’s degree preferred

Job description

SummitRidge Hospital in Lawrenceville, GA, part of Universal Health Services (UHS), is seeking a PRN Utilization Review Coordinator to support behavioral health services on an as-needed basis. You will coordinate utilization review activities, secure timely insurance authorizations, and ensure compliance with payer requirements.

Ideal candidates bring experience in behavioral health or utilization management, strong communication skills, and meticulous attention to detail in a fast-paced