PRN Utilization Review Coordinator - Behavioral Health

Universal Health Services, Inc.; Lawrenceville (GA); On-site; USD 40,000 - 60,000; Part time

Job summary

SummitRidge Hospital, part of Universal Health Services, is seeking a PRN Utilization Review Coordinator to support our behavioral health services in Lawrenceville, GA on an as-needed basis. The role ensures timely insurance authorizations and regulatory compliance, coordinating reviews and patient care updates with care teams.

The ideal candidate brings experience in utilization management, strong communication, and meticulous documentation practices within behavioral health settings.

Qualifications

• High school diploma or equivalent required; associate’s or bachelor’s degree preferred
• Previous experience in utilization review, case management, behavioral health, or 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
• 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 HIPAA and facility privacy standards

Skills

Communication skills

Organization

Attention to detail

HIPAA knowledge

Medical terminology

Education

High school diploma

Associate/Bachelor preferred

Tools

Electronic health records

Insurance systems

Computer proficiency

Job description

SummitRidge Hospital, part of Universal Health Services, is seeking a PRN Utilization Review Coordinator to support our behavioral health services in Lawrenceville, GA on an as-needed basis. The role ensures timely insurance authorizations and regulatory compliance, coordinating reviews and patient care updates with care teams.

The ideal candidate brings experience in utilization management, strong communication, and meticulous documentation practices within behavioral health settings.