Utilization Review Specialist

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 while working remotely 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 and schedule peer-to-peer calls as needed
• Ensure compliance with Client, State, Federal, and URAC standards while maintaining the confidentiality of Protected Health Information

Required Qualifications

• High school diploma or equivalent required
• Minimum of 1 year of experience 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)