Senior Utilization Review Specialist

Job Summary

A company is looking for a Senior Utilization Review Specialist focused on Single Case Agreements and Out-of-Network coverage.

Key Responsibilities

• Serve as the primary patient advocate with insurance
• Lead initial reviews with out-of-network insurance companies for pre-certification
• Manage appeals and maintain strong relationships with case managers

Required Qualifications

• Bachelor's Degree or relevant experience
• Previous healthcare or insurance experience required
• Proven ability to collaborate across teams and departments
• Organized and detail-oriented
• Ability to relay detailed patient information in a compassionate and confidential manner