Utilization Review Coordinator

🕒 July 28

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $20 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 5%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Pyramid Healthcare

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

🧘 Wellness

Healthcare • Wellness

Pyramid Healthcare is an integrated behavioral healthcare system that provides personalized treatment for substance use disorders, mental health conditions, and eating disorders across multiple levels of care (detox, inpatient, outpatient) and via telehealth. Founded in Altoona, PA, it operates a family of programs and affiliated brands focused on clinically integrated, person-first care, workforce education and training, and multi-state expansion to improve recovery outcomes and community well-being.

📋 Description

• Perform admission, continued stay and discharge reviews on all managed care clients. • Maintain positive relationships with referral sources and insurance companies. • Track admissions, continued stay and discharge ASAM requirements for county referrals. • Maintain organized system of reporting to counselors when ASAM’s are due and when review calls are to be made. • Maintain current insurance eligibility information through EVS, Navinet, etc. • Monitor Census for accuracy of funding. • Attend clinical staffing to obtain information for client reviews. • Maintain daily UR database accurately. • Perform Act 106 reviews and follow up appeals. • Track all county referrals for documentation of admission calls. • Maintain and participate in chart reviews to ensure proper paperwork is in place. • Work directly with Billing Department to reduce uncovered days of funding. • Investigate cases with insurance and referral sources to recuperate lost days of funding. • Report to the Assessment Manager on a weekly basis. • Manage all self-pay clients and clients with copays, deductibles, coinsurance and liabilities. • Reduce client balances. • Other duties as assigned.

🎯 Requirements

• Associate Degree or equivalent required; Bachelor of Science in Behavioral Health • Intermediate knowledge of computer skills and the internet • Microsoft Office experience (Excel- Intermediate level, Word- Intermediate level) • 3-5 years’ experience in Utilization Review or related position in a healthcare setting.

🏖️ Benefits

• Medical, Dental, and Vision Insurance • Flexible Spending Accounts • Life Insurance • Paid Time Off • 401(k) with Company Match • Tuition Reimbursement • Employee Recognition Programs • Referral Bonus opportunities • And More!