Oregon Licensed Utilization Review Specialist

Job Summary

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

Key Responsibilities

• Coordinate and execute review and research functions for prior authorization requests
• Investigate and prepare cases for RN/MD review regarding medical necessity and eligibility
• Handle incoming calls from providers and members about operational plan functions and prior authorization requests

Required Qualifications

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