Utilization Management Coordinator

Lancaster Behavioral Health Hospital; Lancaster (Lancaster County); On-site; USD 65,000 - 85,000; Full time

Benefits offered by this job

Competitive compensation

Generous paid time off

Medical, dental, vision plans

Tuition reimbursement

401(k) with company match

Job summary

Lancaster Behavioral Health Hospital is seeking a Utilization Management Coordinator to perform daily payer reviews and secure treatment authorizations across managed Medicare, Medicaid, and commercial plans.

The role collaborates with social services, nursing, intake, and operations to ensure timely, accurate documentation and appropriate level of care. Licensure in nursing or social work is preferred, with 1–3 years of UM experience.

Qualifications

• Bachelor’s degree in psychology or related field (or equivalent experience).
• RN or Social Work licensure preferred (LPC/LMHC/LCPC/LMHC/LCSW).
• 1–3 years of utilization management experience preferred.

Responsibilities

• Perform daily clinical reviews with payer types to secure authorization for continued treatment.
• Collaborate with hospital operations to align documentation with patient conditions.
• Educate and guide on level of care requirements and payer expectations for patient acuity.
• Ensure denials are followed up weekly with detailed documentation.
• Maintain up-to-date Midas documentation to ensure payment issues are avoided.

Skills

Utilization Management

Education

Bachelor's degree in psychology or related field

Master’s degree preferred

Tools

Midas

Job description

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.

The Utilization Management Coordinator is responsible for completing the following duties and tasks:

• 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

What Does LBHH Require for this Role?

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.