UR COORDINATOR
UHS
Summary
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.
Job description
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
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
Requirements
- 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
Company overview
Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected providers of hospital and healthcare services, operating as a Fortune 300 corporation headquartered in King of Prussia, Pennsylvania. Founded in 1979, UHS has grown into a major healthcare enterprise with approximately 99,000 employees and annual revenues exceeding $14 billion. The company operates through its subsidiaries, managing 29 acute care hospitals, 331 behavioral health facilities, and 60 outpatient and other facilities across 39 U.S. states, Washington D.C., Puerto Rico, and the United Kingdom. UHS provides comprehensive healthcare services including acute care, behavioral health treatment, cancer centers, and ambulatory surgical centers. The company's strategy focuses on building or acquiring high-quality hospitals in rapidly growing markets and investing in advanced medical equipment and skilled personnel to become the leading healthcare provider in each community it serves. UHS is publicly traded on the New York Stock Exchange (NYSE: UHS) and has established a strong reputation for delivering compassionate, high-quality care while maintaining financial stability and operational excellence.