Utilization Review Specialist

Job Summary

A company is looking for a Utilization Review Specialist to ensure the efficient processing of Utilization Management and Independent Review requests.

Key Responsibilities

• Review and process Independent Review requests for potential conflicts of interest
• Request and organize additional medical documentation for Physician Advisors
• Ensure compliance with Client, State, Federal, and URAC standards while maintaining confidentiality of Protected Health Information

Qualifications

• High school diploma or equivalent required
• Minimum of 1 year in a healthcare-related setting
• Knowledge of HIPAA rules and regulations required
• Prior experience in utilization review or medical management preferred