Utilization Review Specialist
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Job Summary
To support the Ethos Medical Management Team, the full-time Utilization Review Specialist will ensure the efficient and accurate processing of Utilization Management and Independent Review requests remotely, while maintaining compliance with regulations and providing 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 or medical management preferred
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook)
Complete Job Description
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