Utilization Review Specialist | Partial Hospitalization Program
LENAPE VALLEY FOUNDATION
Summary
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.
Job description
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
Requirements
- 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
Benefits
- DailyPay
- Paid training
- 403(b) Retirement Plan
- Generous PTO
- Paid Sick Days
- Paid Personal Days
- Paid Holidays
- Paid Conference Days
- Medical, Dental & Vision
- Flexible Spending Account
- Long-Term Disability
- Basic Life Insurance
- Employee Assistance Program
- Continuing Education Assistance
- Student loan support
Company overview
Lenape Valley Foundation is a comprehensive mental health care organization providing essential behavioral health services to communities in Pennsylvania. As a dedicated healthcare provider, the foundation offers a wide range of mental health and substance abuse treatment programs designed to support individuals and families facing behavioral health challenges. Their services typically include outpatient counseling, crisis intervention, psychiatric evaluations, medication management, and community-based support programs. The organization focuses on delivering accessible, quality mental health care while promoting mental wellness and recovery through evidence-based practices. Lenape Valley Foundation plays a crucial role in addressing the mental health needs of its community by providing integrated care that combines clinical expertise with compassionate support. Their mission centers on improving mental health outcomes and enhancing the quality of life for those they serve through comprehensive treatment approaches and community education initiatives.