Utilization Review Coordinator

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluate and interpret medical records, treatment strategies, and clinical documentation to determine the necessity and suitability of healthcare services.

• Collaborate with healthcare practitioners, insurance agents, and case managers to gather further details and clarify treatment specifics.

• Make determinations regarding the authorization, continuation, modification, or denial of services as per clinical guidelines and regulatory standards.

• Keep precise and comprehensive records of utilization review activities, decisions, and communications in accordance with organizational policies and legal requirements.

• Remain up-to-date with the latest healthcare regulations, payer policies, and clinical best practices.

• Ensure timely approvals and enhance patient outcomes.

• Assist in managing healthcare costs while ensuring high standards of patient care.

⛳️ Requirements

• Bachelor’s degree in healthcare or a related discipline.

• A minimum of 2 years of experience in utilization review, case management, or clinical healthcare positions.

• Strong understanding of medical terminology, clinical procedures, and healthcare regulations.

• Knowledge of insurance authorization processes and healthcare reimbursement systems.

• Exceptional analytical, communication, and organizational abilities.

• Familiarity with electronic health records (EHR) systems and utilization management software is preferred.

• Certification in Utilization Review (such as Certified Professional in Utilization Review or Certified Case Manager) is preferred.

• Previous experience with managed care organizations or insurance firms is preferred.

• Advanced understanding of Medicare, Medicaid, and other payer-specific regulations is preferred.

• Availability Monday–Friday, from 8:00 AM to 5:00 PM.

🏝️ Benefits

• Medical Coverage – Three new BCBSAL medical plans featuring improved rates, better co-pays, and enhanced prescription benefits.

• Expanded Coverage – Options available for domestic partners and a broader network of in-network providers.

• Mental Health Support – Enhanced access to services and a new Employee Assistance Program (EAP) offering digital wellness tools including Cognitive Behavioral Therapy (CBT) modules and wellness coaching.

• Voluntary Coverages – Options for pet insurance, home and auto insurance, family legal services, and more.

• Student Loan Repayment – Available for nurses and therapists.

• Retirement Benefits – 401(k) plan through Voya.

• Generous PTO – A comprehensive paid time off policy.

• Voluntary Benefits for Part-Time Employees – Dental, vision, life, accident insurance, and telehealth options for those working 20 hours or more per week.

• Great Place to Work® Certification and a supportive workplace culture.