State Licensed Utilization Coordinator
Job Summary
To support utilization review cases, the full-time State Licensed Utilization Coordinator will manage medical reviews, analyze member cases for treatment authorizations, and liaise with internal and external partners while working remotely.
Key responsibilities
- Provide timely medical reviews and clinical determinations based on evidence-based criteria
- Conduct reporting in coordination with service level agreements for federal and non-federal clients
- Outreach to providers to obtain necessary documentation for authorization requests
Required qualifications
- Bachelor's degree in nursing
- 3+ years of fertility nursing experience
- Current licensed professional registered nurse
- Knowledge of CPT, HCPCS, ICD-10 codes, and medical terminology
- Experience with CRM platforms, specifically Salesforce, and reporting/dashboard management
Complete Job Description
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