Utilization Review Coordinator

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

📋 Description

• Manage utilization review requests effectively.

• Confirm and input data into the relevant system(s).

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

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

• Handle telephone inquiries, delivering accurate information and triaging as needed.

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

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

• Manage incoming and outgoing correspondence, faxes, and mail; upload review documents into a paperless system as required.

• Provide support to other units as necessary.

⛳️ Requirements

• High School diploma or GED is mandatory.

• A minimum of two (2) years of administrative experience or a relevant combination of experience and education is required.

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

• Prior experience with workers compensation, disability, and/or liability claims processing is advantageous.

• Familiarity with medical and insurance terminology is essential.

• Understanding of ICD9 and CPT coding is necessary.

• Strong oral and written communication skills, including proficiency in presentation skills.

• Proficiency in PC use, particularly Microsoft Office applications.

• Possess analytical and interpretive skills.

• Excellent organizational abilities.

• Detail-oriented approach.

• Strong interpersonal skills.

• Ability to collaborate effectively in a team environment.

• Capability to meet or exceed Performance Competencies.

🏝️ Benefits

• Selection from three medical and two dental plans.

• Eligibility for tuition reimbursement.

• 401K plan that matches 50% of every dollar contributed, up to the first 6% saved.

• Four weeks of PTO in your first full year.