Utilization Review Specialist
Job Summary
To support the Ethos Medical Management Team, the full-time Utilization Review Specialist will ensure the efficient and timely processing of Utilization Management and Independent Review requests remotely, while maintaining compliance and delivering exceptional client service.
Key Responsibilities
- Review and process Independent Review requests for potential conflicts of interest
- Request and organize additional medical documentation for Physician Advisors
- Ensure all work meets Client, State, Federal, and URAC compliance standards
Required 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, medical management, or insurance preferred
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook)
Complete Job Description
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