Utilization Review Specialist

Job Summary

To ensure the delivery of medically necessary and efficient healthcare services, the full-time Utilization Review Specialist will evaluate patient records and treatment plans, collaborate with healthcare providers and insurance companies, and maintain compliance with regulatory standards while working remotely.

Key responsibilities:

• Review and analyze medical records and clinical documentation to assess the necessity of healthcare services
• Coordinate with healthcare providers and insurance representatives to clarify treatment details and obtain additional information
• Make informed decisions regarding the authorization or denial of services based on clinical guidelines and regulations

Required qualifications:

• Bachelor's degree in a healthcare or related field
• At least 2 years of experience in utilization review, case management, or clinical healthcare roles
• Strong knowledge of medical terminology, clinical procedures, and healthcare regulations
• Familiarity with insurance authorization processes and healthcare reimbursement models
• Excellent analytical and organizational skills