Utilization Management Specialist - Care Coordination

SUN Kentucky; Erlanger (KY); Hybrid; USD 36,000 - 60,000; Full time

Job summary

SUN Behavioral Kentucky seeks an Utilization Management Specialist 1 in Erlanger, KY to coordinate case management from pre-admission through discharge and assist with admission authorizations. This role requires coordinating with physicians, nurse practitioners, and care teams to ensure appropriate levels of care and timely documentation.

The position emphasizes adherence to safety, integrity, compassion, and teamwork while supporting performance improvement activities and clinical review

Qualifications

• High school diploma or GED is required.
• CPR and hospital-selected de-escalation technique certification required.
• Associates or Bachelor's degree preferred; may substitute experience for education.
• One year of experience in a behavioral healthcare setting required.
• Previous experience in Utilization Management or as a Mental Health Tech preferred.

Responsibilities

• Coordinate case management from pre-hospitalization through discharge.
• Assist with authorization of admissions to hospital and maintain documentation in EMR.
• Conduct retroactive reviews and appeals; prepare letters for insurance providers.
• Communicate with physicians, nurses, and other care teams to ensure appropriate level of care.
• Participate in performance improvement activities and safety initiatives.

Education

High school diploma or GED

CPR certification

De-escalation technique certification

Associates or Bachelor's degree preferred

Job description

SUN Behavioral Kentucky seeks an Utilization Management Specialist 1 in Erlanger, KY to coordinate case management from pre-admission through discharge and assist with admission authorizations. This role requires coordinating with physicians, nurse practitioners, and care teams to ensure appropriate levels of care and timely documentation.

The position emphasizes adherence to safety, integrity, compassion, and teamwork while supporting performance improvement activities and clinical review