Associate Utilization Review Specialist

Job Summary

A company is looking for an Associate Utilization Review Specialist who will manage prior authorization processes and support healthcare operations.

Key Responsibilities

• Manage core functions in the Prior Authorization Department, including reviewing and preparing requests
• Investigate and assess cases for RN/MD review regarding coverage and medical necessity
• Handle incoming calls from providers and members, ensuring compliance with regulatory requirements

Required Qualifications

• Bachelor's Degree in a health-related field or 2 years of applicable work experience
• 2 years of experience in a healthcare-related field or equivalent education
• 1 year of experience in researching and resolving complex problems
• 2 years of experience in a fast-paced work environment with a record of meeting metrics
• 1 year of experience in database management and spreadsheets