UR COORDINATOR

Responsibilities SummitRidge Hospital provides quality behavioral health and addiction treatment services in Lawrenceville, GA, approximately 30 miles northeast of downtown Atlanta. Our dedicated team of professionals provide caring and professional inpatient, outpatient and support services to adults and adolescents suffering from psychiatric or addictive disorders. Additionally, the Geriatric unit provides acute care for seniors in psychiatric crisis. SummitRidge Hospital is seeking a PRN Utilization Review Coordinator to support our behavioral health facility on an as-needed basis. This role is responsible for coordinating utilization review activities, supporting timely insurance authorization processes, and ensuring compliance with payer requirements. The ideal candidate will have strong communication skills, attention to detail, and experience in behavioral health or utilization management. Key Responsibilities Conduct utilization review functions for assigned patients in accordance with facility policies and payer guidelines Obtain, track, and maintain insurance authorizations, continued stay reviews, and discharge planning updates Communicate effectively with insurance companies, clinical staff, and other care team members Ensure documentation is accurate, timely, and compliant with regulatory and payer standards Support coordination of patient care updates related to level of care and medical necessity Assist with appeals, denials, and other utilization management processes as needed Maintain confidentiality and adhere to all HIPAA and facility privacy standards About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $13.4 billion in 2022. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 94,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. Qualifications High school diploma or equivalent required; associate’s or bachelor’s degree preferred Previous experience in utilization review, case management, behavioral health, or a related healthcare setting preferred Knowledge of insurance authorization processes, payer requirements, and medical necessity criteria Strong organizational, communication, and problem-solving skills Ability to work independently and maintain professionalism in a fast-paced environment Proficiency with computer systems and electronic documentation Previous experience with third party payors. Must be familiar with utilization negotiations. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success. Qualifications High school diploma or equivalent required; associate’s or bachelor’s degree preferred Previous experience in utilization review, case management, behavioral health, or a related healthcare setting preferred Knowledge of insurance authorization processes, payer requirements, and medical necessity criteria Strong organizational, communication, and problem-solving skills Ability to work independently and maintain professionalism in a fast-paced environment Proficiency with computer systems and electronic documentation Previous experience with third party payors. Must be familiar with utilization negotiations. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success. SummitRidge Hospital provides quality behavioral health and addiction treatment services in Lawrenceville, GA, approximately 30 miles northeast of downtown Atlanta. Our dedicated team of professionals provide caring and professional inpatient, outpatient and support services to adults and adolescents suffering from psychiatric or addictive disorders. Additionally, the Geriatric unit provides acute care for seniors in psychiatric crisis. SummitRidge Hospital is seeking a PRN Utilization Review Coordinator to support our behavioral health facility on an as-needed basis. This role is responsible for coordinating utilization review activities, supporting timely insurance authorization processes, and ensuring compliance with payer requirements. The ideal candidate will have strong communication skills, attention to detail, and experience in behavioral health or utilization management. Key Responsibilities Conduct utilization review functions for assigned patients in accordance with facility policies and payer guidelines Obtain, track, and maintain insurance authorizations, continued stay reviews, and discharge planning updates Communicate effectively with insurance companies, clinical staff, and other care team members Ensure documentation is accurate, timely, and compliant with regulatory and payer standards Support coordination of patient care updates related to level of care and medical necessity Assist with appeals, denials, and other utilization management processes as needed Maintain confidentiality and adhere to all HIPAA and facility privacy standards About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $13.4 billion in 2022. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 94,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. Qualifications High school diploma or equivalent required; associate’s or bachelor’s degree preferred Previous experience in utilization review, case management, behavioral health, or a related healthcare setting preferred Knowledge of insurance authorization processes, payer requirements, and medical necessity criteria Strong organizational, communication, and problem-solving skills Ability to work independently and maintain professionalism in a fast-paced environment Proficiency with computer systems and electronic documentation Previous experience with third party payors. Must be familiar with utilization negotiations. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success. #J-18808-Ljbffr Another Source