Utilization Review Coordinator

Job Summary

A company is looking for a Utilization Review Coordinator.

Key Responsibilities

• Handle pre-certifications, authorizations, retro-authorizations, appeals, and chart auditing duties
• Conduct live reviews with payors and negotiate authorization outcomes in collaboration with clinicians
• Coordinate interdepartmental communication and provide guidance on maximizing authorized days and compliance

Required Qualifications

• Bachelor's degree in Social Work, Nursing, or a related field
• Clinical or utilization review experience in PHP or IOP levels of care
• At least 4+ years of experience in the healthcare industry focused on utilization review or clinical care
• Expert understanding of patient documentation and regulatory requirements
• Proficient in MS Office applications and capable of learning job-specific software systems