California Licensed Utilization Review Specialist

Job Summary

A company is looking for an Associate Utilization Review Specialist who will be responsible for core functions in the Prior Authorization Department.

Key Responsibilities

• Coordinate and execute review and research functions to support the Prior Authorization Department
• Investigate and prepare requests for prior authorization review across multiple applications
• Manage incoming calls from providers and members regarding operational plan functions and prior authorization requests

Required Qualifications

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