Utilization Management Coordinator

Henderson Hospital; Lancaster (Lancaster County); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Competitive salary

Tuition reimbursement

401(k) with company match

Career development opportunities

Job summary

Lancaster Behavioral Health Hospital is seeking a qualified professional to manage utilization review and payer communications on-site in Lancaster, PA. You will coordinate with social services, nursing, and intake to ensure timely, accurate documentation and appropriate care levels.

Qualifications include a psych-related bachelor’s, with a master’s preferred, and experience in utilization management. RN or social work licensure is desirable; this role emphasizes collaboration and compliance

Qualifications

• Bachelor’s degree in psychology- or psychiatry-related field or equivalent experience.
• Master’s degree preferred.
• Licensure in nursing or social work as applicable.

Responsibilities

• Performs timely clinical reviews with payer types to secure authorization for continued treatment.
• Collaborates with hospital operations to align documentation with patient conditions.
• Educates treatment team on level of care requirements and payer expectations.
• Monitors denials and ensures documentation supports payment.
• Ensures Midas documentation is updated daily with sufficient detail.

Skills

Utilization Management

Education

Bachelor’s degree in psych related field

Master's degree preferred

Job description

Responsibilities

Lancaster Behavioral Health Hospital (LBHH) is a 126-bed, inpatient psychiatric hospital and joint venture between Lancaster General Health/Penn Medicine and Universal Health Services.

In addition to a general adult unit and dedicated adolescent unit, the facility offers services for treating those with co-occurring disorders on the psychiatric-medical unit, an intensive adult unit to care for those with severe conditions, as well as a women's trauma unit.

This position is NOT a remote position!

• Performs timely, daily clinical reviews with all payer types (Managed Medicare, Managed Medicaid and commercial) to secure authorization for continued treatment (i.e. by fax, telephone or on-line) based on payer’s criteria.
• Works collectively with hospital operations (social services, business office, Intake, Nursing) to ensure timely documentation is aligned with patient conditions.
• Functions as a key member of the multidisciplinary treatment team to educate and guide on level of care requirements and payer expectations for patient acuity and appropriate utilization.
• Ensure that all denials are followed up weekly and documentation is detailed.
• Assures that Midas documentation is updated daily and appropriately. That all documentation has enough detail to ensure no issues with payment.

What do our current employees value at LBHH?

• An environment that puts patient care first.
• One of the most rewarding aspects of working at LBHH is providing excellent care, comfort, and security to the patients and families you treat, at their most vulnerable times.
• Having the opportunity to grow, learn, and advance in your career.
• There are very robust continuing education options and opportunities for leadership development.
• Supportive and responsive leadership.
• Competitive salary and comprehensive benefits package.

What’s in it for me?

• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• Robust tuition reimbursement
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!
• An opportunity to make a difference every single day

Qualifications

Education: Bachelor’s degree in psych related field and/or equivalent combination of education and experience. Masters preferred.

Licensure: Registered Nurse or Social Work, Marriage and Family, Mental Health Counseling (i.e. LPC, LMHC, LCSW, LCPC, LPCC) preferred.

Experience: 1 to 3 years of Utilization Management preferred.

Lancaster Behavioral Health Hospital: Treatment. Compassion. Hope. Today, tomorrow and always.

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.