Utilization Review Specialist | Partial Hospitalization Program

Socket.dev; Doylestown (Bucks County); On-site; USD 55,000 - 70,000; Full time

Benefits offered by this job

DailyPay

Paid training and supervision

403(b) Retirement Plan

Full-Time Benefits

Job summary

Lenape Valley Foundation is seeking a Utilization Review Specialist to bridge clinical care and insurance providers for our Partial Hospitalization Program. You will oversee authorizations, utilization review activities, outcome tracking, and care coordination to ensure timely access to medically necessary treatment.

The role operates Monday–Friday 8:30 am to 3:30 pm in Bucks County, PA, with a focus on reducing denials and improving program efficiency.

Qualifications

• Healthcare-related education preferred and relevant experience welcomed.
• Strong computer skills and experience with electronic health records (EHR).
• Excellent verbal and written communication abilities.

Responsibilities

• Manage insurance authorizations for PHP clients, including initial, concurrent, and continued-stay requests.
• Serve as primary contact with insurance companies and utilization management.
• Review clinical information and submit documentation supporting medical necessity.
• Monitor authorization deadlines, approvals, denials, and requests for additional information.
• Coordinate with treatment team on stays, discharge planning, and care transitions.
• Run PROMIS assessments daily and track program outcomes.

Skills

EHR experience

Verbal and written communication

Education

Bachelor’s degree in human services or related field

Job description

Join Our Team

Make a meaningful impact behind the scenes of behavioral healthcare.Lenape Valley Foundation is seeking a Utilization Review Specialist to support our growing Partial Hospitalization Program (PHP). This newly created role serves as the bridge between our clinical team and insurance providers, ensuring clients receive timely access to medically necessary treatment while supporting efficient program operations. As a key member of our interdisciplinary team, you will oversee insurance authorizations, utilization review activities, outcome tracking, and care coordination while helping patients access the services they need. The hours for this position are Monday-Friday 8:30 am – 3:30 pm.

What We Offer

• DailyPay-gives you the flexibility to access your earnings immediately- on your own schedule!
• Paid training and supervision
• 403(b) Retirement Plan
• FULL TIMEBenefits Package Includes:
  • Generous PTO Policy
    • 15 PTO Days, 10 Paid Sick Days, 4 Paid Personal Days, 7 Paid Holidays, 5 Paid Conference Days
  • Medical, Dental, and Vision Insurance
    • Credit available for medical opt-out
  • Flexible Spending Account (FSA)
  • Long-Term Disability and Basic Life Insurance
  • Employee Assistance Program (EAP)
  • Continuing Education Assistance Program
  • Access to student loan management and repayment support

What You Bring

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

Your Role

• 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

About Lenape Valley Foundation

Since 1958, Lenape Valley Foundation (LVF) has been a trusted non-profit provider of essential human services in Bucks and Montgomery Counties. Our mission is to partner with individuals facing mental health, substance use, or developmental challenges as they pursue personal goals and improved quality of life. With over 30 programs and a commitment to evidence-based care, LVF continues to evolve to meet community needs.

Our Commitment To Diversity and Inclusion

LVF is an Equal Opportunity Employer. We are committed to fostering a workplace that respects and celebrates diversity. We welcome applicants of all backgrounds and ensure a discrimination and harassment free environment where everyone is treated with dignity.