Utilization Review Analyst

Eagleville Hospital; Eagleville (PA); On-site; USD 50,000 - 57,000; Full time

Job summary

Eagleville Hospital is seeking an individual to oversee the review and abstraction of medical records to maintain financial coverage. This role involves collaboration with various insurance companies, ensuring compliance with treatment requirements.

Applicants should possess a Bachelor’s degree and have at least 3 years of experience in utilization review or case management in substance use/behavioral health. Strong communication skills and the ability to work independently are essential.

The role is office-based with a focus on patient-centered care and professionalism in a supportive environment.

Qualifications

• 3+ years of UR or case management experience in Substance Use/Behavioral Health.
• Good communication skills.
• Ability to work independently.
• Experience with Microsoft applications.
• Knowledge of pre-certification process and ASAM.
• Knowledge of DSM V, private care managers and county referral sources.

Responsibilities

• Reviews admissions to determine medical necessity and appropriateness of treatment.
• Communicates necessary data for extended stay reviews.
• Presents abstracts via telecon to justify continued treatment.
• Notifies clinical teams of current documentation needs.

Skills

Good communication

Ability to work independently

Experience with Microsoft applications

Knowledge of pre-certification process and ASAM

Knowledge of DSM V

Education

Bachelor’s Degree Preferred

Job description

Job Details

Job Location: Eagleville Hospital, Eagleville, PA 19403
Education Level: High School
Travel Percentage: None
Job Shift: 1st shift
Job Category: Health Care

Eagleville Hospital, an independent substance use and behavioral health treatment and educational organization serving the community for more than a century, provides innovative compassionate care to those seeking treatment for stigmatized illnesses including substance use and mental health.

Position Summary

Review and abstract pertinent data from medical records and communicates information to all various insurance companies and/or their contractual agencies to guarantee continued financial coverage.

This position reports to the Utilization Review Director.

Objectives / Responsibilities

• Reviews admissions to determine medical necessity and appropriateness of treatment.
• Reviews patient records to obtain justification of treatment.
• Secures necessary data from the clinical team for extended stay reviews.
• Presents abstracts (via telecon) of clinical course of treatment to all various insurance companies and/or their contractual agencies, to justify continued treatment.
• Review, abstract and assigns initial length of stay and extensions of treatment as appropriate for all payers as assigned.
• Communicates all extensions of treatment to clinical teams and Director, Utilization Review (UR).
• Notify clinical teams of need for current documentation.
• Refer cases to Director, UR when appropriateness of and necessity of extended stay is questionable.
• Attend appropriate daily treatment team meeting.

Salary Range: $50-$57/yr

Educational Requirements

Bachelor’s Degree Preferred

Competencies

• Patient-Centered Approach – Treat all individuals with dignity, empathy, and respect, recognizing that every role contributes to the patient experience.
• Excellence & Accountability – Perform all duties with professionalism, following hospital policies to ensure safety, compliance, and efficiency.
• Teamwork & Communication – Collaborate with colleagues across departments, maintaining a positive and solution-oriented attitude.
• Commitment to Our Mission – Uphold the hospital’s values and contribute to a culture of trust, inclusivity, and continuous improvement.

Qualifications

• 3+ years of UR or case management experience in Substance Use /Behavioral Health.
• Good communication.
• Ability to work independently.
• Experience with Microsoft applications.
• Knowledge of pre-certification process and ASAM.
• Knowledge of DSM V, private care managers and county referral sources.

Physical Requirements

• Ability to sit for long periods.
• Ability to walk around campus if needed.
• Good dexterity, must be able to type.
• Use of telephone.

Work Environment

Office setting.