Utilization Review Coordinator

Job Description

We are seeking a detail-oriented Utilization Review Coordinator to manage medical service requests and ensure they comply with our health plan's policies. You will work closely with healthcare providers to assess the necessity of services.

Responsibilities

• Evaluate requests for medical services, ensuring they adhere to established healthcare guidelines.
• Work jointly with medical personnel to confirm the necessity and appropriateness of services.
• Effectively communicate review findings to physicians and staff.
• Document all actions taken during the review process.
• Participate in departmental meetings to discuss process improvements.
• Assist in regulatory audits as needed.

Requirements

Education

• Bachelor's degree in healthcare administration, nursing, or related field
• Master's degree in healthcare administration or related field is a plus

Experience

• 3-5 years of experience in utilization review or similar field

Technical Skills

• Utilization Review Software
• Microsoft Office Suite

Soft Skills

• Teamwork
• Time Management

Certifications

• Certified Utilization Review Coordinator (CURC)

Languages

• English: Fluent

Advantageous

• Master's degree in healthcare administration: Preferred for those seeking leadership roles within Utilization Management.
• Experience in Quality Assurance: Knowledge of the quality improvement process within healthcare settings.

Benefits

• Comprehensive health, dental, and vision insurance.
• 401(k) plan with generous matching contributions.
• Flexible work hours with the option for remote work.
• Ongoing career development and training opportunities.

Company Culture

• Innovation Focus: We embrace innovative approaches to improve healthcare delivery and patient outcomes.
• Continuous Improvement: Our culture is built around feedback and growth, encouraging all employees to pursue development opportunities.
• Team Collaboration: Teamwork is at the heart of our success; we thrive when we work together.