PRN Utilization Review Coordinator - Behavioral Health

SummitRidge Hospital; Lawrenceville, Northern (GA, KY); Hybrid; USD 39,000 - 55,000; Part time

Job summary

SummitRidge Hospital in Lawrenceville, GA, seeks a PRN Utilization Review Coordinator to support behavioral health services on an as-needed basis. You will coordinate utilization review activities, obtain authorizations, and ensure compliance with payer requirements, while communicating with insurance companies and clinical staff.

The ideal candidate has strong attention to detail, excellent communication, and prior experience in utilization management or behavioral health.

Qualifications

• High school diploma or equivalent required; associate’s or bachelor’s degree preferred
• 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
• 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

Communication skills

Organization

Problem solving

Electronic documentation

Independent work

Education

High school diploma or equivalent

Associate or Bachelor’s degree preferred

Tools

Electronic health records (EHR)

Insurance authorization systems

Job description

SummitRidge Hospital in Lawrenceville, GA, seeks a PRN Utilization Review Coordinator to support behavioral health services on an as-needed basis. You will coordinate utilization review activities, obtain authorizations, and ensure compliance with payer requirements, while communicating with insurance companies and clinical staff.

The ideal candidate has strong attention to detail, excellent communication, and prior experience in utilization management or behavioral health.