Oregon Licensed Utilization Review Specialist

Job Summary

A company is looking for an Associate Utilization Review Specialist who will work remotely.

Key Responsibilities

• Perform core functions in the Prior Authorization Department, including reviewing and researching requests
• Investigate and prepare cases for RN/MD review, ensuring compliance with medical necessity and eligibility
• Handle incoming calls from providers and members, addressing prior authorization inquiries and operational issues

Required Qualifications

• Bachelor's Degree in a health-related field or 2 years of relevant work experience
• 2 years of experience in a healthcare-related field
• 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 quality metrics
• 1 year of experience in database management and spreadsheets