PRN Utilization Review Coordinator

Talentify; Lawrenceville (GA); On-site; USD 42,000 - 64,000; Part time

Job summary

SummitRidge Hospital in Lawrenceville, GA seeks a PRN Utilization Review Coordinator to support our behavioral health facility on an as-needed basis. This role coordinates utilization review activities, supports timely insurance authorizations, and ensures compliance with payer requirements in a fast-paced hospital setting.

The ideal candidate will have strong communication skills, meticulous attention to detail, and experience in behavioral health or utilization management.

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

Job description

SummitRidge Hospital in Lawrenceville, GA seeks a PRN Utilization Review Coordinator to support our behavioral health facility on an as-needed basis. This role coordinates utilization review activities, supports timely insurance authorizations, and ensures compliance with payer requirements in a fast-paced hospital setting.

The ideal candidate will have strong communication skills, meticulous attention to detail, and experience in behavioral health or utilization management.