Utilization Review Coordinator

Job Summary

To support clinical staff in a collaborative environment, the full-time Utilization Review Coordinator will manage utilization review requests, verify and enter data into systems, and respond to inquiries while working remotely.

Key responsibilities

• Access, triage, and assign cases for utilization review (UR)
• Enter demographics and UR information into claims or clinical management systems, ensuring data integrity
• Obtain necessary information for UR processing from internal and external sources in accordance with policies and procedures

Required qualifications

• High School diploma or GED required
• Two years of administrative experience or equivalent combination of experience and education required
• Customer service experience in the medical field preferred
• Knowledge of medical and insurance terminology, including ICD9 and CPT coding
• PC literate, including proficiency in Microsoft Office products