Utilization Review Specialist | Partial Hospitalization Program

LENAPE VALLEY FOUNDATION•Doylestown, PA

11d•Onsite

About The Position

Lenape Valley Foundation is seeking a Utilization Review Specialist to support its growing Partial Hospitalization Program (PHP). This role acts as a liaison between the clinical team and insurance providers, managing insurance authorizations, utilization review, outcome tracking, and care coordination to ensure clients receive timely access to medically necessary treatment and to support efficient program operations. The hours for this position are Monday-Friday 8:30 am – 3:30 pm.

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

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

Benefits

DailyPay - access earnings immediately
Paid training and supervision
403(b) Retirement Plan
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