Utilization Review Coordinator

Job Summary

A company is looking for a Utilization Review Coordinator to manage pre-certifications, authorizations, appeals, and related tasks in a remote setting.

Key Responsibilities

• Conduct utilization reviews, prescreen referrals, and negotiate authorization outcomes with payors
• Coordinate interdepartmental communication and provide guidance on insurance reviews and clinical documentation
• Ensure compliance with policies and regulations while identifying areas for process improvement

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
• 1-2 years of experience in the healthcare industry related to utilization review or clinical care
• Expert understanding of patient documentation and regulatory requirements
• Proficient in MS Office and capable of learning job-specific software systems