Utilization Review Specialist - Partial Hospitalization (PHP)

Lenape Valley Foundation; Doylestown (Bucks County); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

DailyPay

Paid training

403(b) retirement

Full benefits

PTO

Medical insurance

Dental insurance

Vision insurance

FSA

Long-term disability

Life insurance

EAP

CE support

Job summary

Lenape Valley Foundation, based in Doylestown, PA, seeks an Utilization Review Assistant to support the Partial Hospitalization Program. You will manage insurance authorizations, review medical necessity, and coordinate with clinical teams to ensure timely access to services.

The role emphasizes collaboration with insurance providers, monitoring deadlines, and contributing to program efficiency while supporting patients and families in navigating care transitions.

Qualifications

• Bachelor’s degree in human services, Psychology, Social Work, Sociology, or related field preferred.
• Strong verbal and written communication skills.
• Ability to meet the physical demands of the role, with or without accommodation.

Responsibilities

• Manage insurance authorizations for PHP clients, including initial, concurrent, and continued-stay requests.
• Serve as the primary contact with insurance companies and utilization management departments.
• Review clinical information and submit documentation supporting medical necessity.
• Monitor authorization deadlines, approvals, denials, and requests for additional information.
• Coordinate with the treatment team on continued stays, discharge planning, and care transitions.
• Run daily PROMIS assessments and track program outcomes.
• Assist with referrals to outpatient services and community resources.
• Maintain accurate documentation and authorization records within the EHR.
• Help identify opportunities to reduce denials and improve program efficiency.
• Perform other duties as assigned.

Skills

Verbal communication

Written communication

Physical stamina

Education

Bachelor’s degree in human services, Psychology, Social Work, Sociology, or related field

Job description

Lenape Valley Foundation, based in Doylestown, PA, seeks an Utilization Review Assistant to support the Partial Hospitalization Program. You will manage insurance authorizations, review medical necessity, and coordinate with clinical teams to ensure timely access to services.

The role emphasizes collaboration with insurance providers, monitoring deadlines, and contributing to program efficiency while supporting patients and families in navigating care transitions.