Utilization Review Coordinator

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

📋 Description

• Assign requests for utilization review.

• Verify and input data into the appropriate system(s).

• Offer general assistance to clinical staff within a team setting.

• Access, evaluate, and allocate cases for utilization review (UR).

• Respond to phone inquiries, providing accurate information and triaging as required.

• Input demographic and UR information into claims or clinical management systems while ensuring data integrity.

• Gather all essential information needed for UR processing from both internal and external sources in accordance with policies and procedures.

• Manage the distribution of incoming and outgoing correspondence, faxes, and mail; upload review documents into the paperless system as needed.

• Provide support to other units as necessary.

⛳️ Requirements

• A High School diploma or GED is required.

• Two (2) years of administrative experience or a comparable combination of experience and education is required.

• Experience in customer service within the medical field is preferred.

• Background in workers' compensation, disability, and/or liability claims processing is preferred.

• Familiarity with medical and insurance terminology.

• Knowledge of ICD9 and CPT coding.

• Exceptional oral and written communication skills, including presentation abilities.

• Proficient in PC applications, including Microsoft Office products.

• Strong analytical and interpretive skills.

• Excellent organizational abilities.

• Attention to detail.

• Strong interpersonal skills.

• Ability to collaborate effectively within a team environment.

• Capability to meet or exceed Performance Competencies.

🏝️ Benefits

• Commitment to Sedgwick’s caring counts® initiative.

• Opportunities for career growth with us.

• Emphasis on work-life balance.

• Supportive and caring workplace culture.