Utilization Review Coordinator
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Utilization Review Coordinator evaluating medical necessity and authorizations for Bradford Health Services’ addiction treatment programs. Coordinating with providers, insurers, and case managers to support compliant patient care.
Responsibilities:
- Review and analyze medical records, treatment plans, and clinical documentation to assess the necessity and appropriateness of healthcare services
- Coordinate with healthcare providers, insurance representatives, and case managers to obtain additional information and clarify treatment details
- Make decisions regarding authorization, continuation, modification, or denial of services based on clinical guidelines and regulatory requirements
- Maintain accurate and detailed records of utilization review activities, decisions, and communications in compliance with organizational policies and legal standards
- Stay current with evolving healthcare regulations, payer policies, and clinical best practices
- Facilitate timely approvals and optimize patient outcomes
- Help control healthcare costs while maintaining high-quality patient care
Requirements:
- Bachelor’s degree in a healthcare or related field
- At least 2 years of experience in utilization review, case management, or clinical healthcare roles
- Strong knowledge of medical terminology, clinical procedures, and healthcare regulations
- Familiarity with insurance authorization processes and healthcare reimbursement models
- Excellent analytical, communication, and organizational skills
- Experience with electronic health records (EHR) systems and utilization management software preferred
- Certification in Utilization Review (e.g., Certified Professional in Utilization Review or Certified Case Manager) preferred
- Prior experience working with managed care organizations or insurance companies preferred
- Advanced knowledge of Medicare, Medicaid, and other payer-specific guidelines preferred
- Monday–Friday availability, 8:00 AM–5:00 PM
Benefits:
- Medical Coverage – Three new BCBSAL medical plans with better rates, improved co-pays, and enhanced prescription benefits
- Expanded Coverage – Options for domestic partners and a wider network of in-network providers
- Mental Health Support – Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching
- Voluntary Coverages – 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 robust 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 supportive workplace culture
Similar Jobs
Environmental Impact Assessment Professional
Environmental assessment leader guiding regulatory approvals for Onterris’ resource, infrastructure, energy, and mining projects. Advising executives, regulators, Indigenous communities, and clients while leading multidisciplinary teams.
Patient Engagement Specialist
Patient Engagement Specialist connecting eligible patients with HarmonyCares’ in-home primary care services. Conducting patient outreach, explaining programs, gathering needs, and scheduling appointments.
Senior Criminal Enforcement Officer
Principal Intelligence Analyst leading intelligence assessments for MHRA, which regulates medicines and medical devices. Supporting criminal enforcement and public-health protection across the UK.
Asset Management Specialist
Asset Management Specialist managing construction draws, delinquencies, maturities, and borrower communication. Supporting New Silver’s fintech real estate lending and servicing operations.
Subcontracts Specialist
Subcontracts Specialist managing procurement lifecycles, supplier risk, and negotiations for L3Harris defense and aerospace programs. Supporting compliant delivery of specialized materials, equipment, and services.
Foster Parent
Foster parent providing safe, stable homes for Colorado children with intellectual and developmental disabilities. Coordinating daily care, education, appointments, documentation, and professional support.
Foster Parent
Foster parent providing safe, nurturing homes for Colorado children with intellectual and developmental disabilities. Coordinating daily care, appointments, education, and professional supports.
Foster Parent
Foster parent providing safe, stable homes for Colorado children with intellectual and developmental disabilities. Receiving training, respite, compensation, and 24/7 support from Sample Supports.
Chief Clinical Informatics Officer
Clinical informatics executive advancing Bon Secours Mercy Health’s enterprise digital health, informatics, and AI strategy. Leading transformation, governance, and digital patient experience across complex health systems.
Post Closing Specialist
Post Closing Specialist resolving investor conditions and preparing disclosures for CrossCountry Mortgage, a distributed retail mortgage lender. Monitoring loan pipelines, documentation, and purchase timelines.
Revenue Development Specialist
Revenue Development Specialist growing sales for The RealReal’s authenticated luxury resale marketplace. Re-engaging consignors, developing opportunities, and closing across multiple channels.
Hospice Triage RN, PT 3:30 PM - 11 PM, Rotating Sat & Sun 9:30 AM - 4 PM CST
Remote hospice triage RN providing after-hours telephone support for hospice patients and families. Coordinating care through IntellaTriage’s nurse-led, technology-enabled services.
Hospice Triage RN, PT
Remote hospice triage RN providing after-hours telephone support for IntellaTriage’s hospice and home health clients. Assessing patients, coordinating care, and documenting urgent calls.
Hospice Triage RN, PT
Remote RN providing after-hours telephone triage for hospice patients and families. Coordinating urgent care, documenting interventions, and supporting hospice providers through IntellaTriage’s nurse triage service.
Hospice Triage RN, PT, 3:30p-11p, Rotating Sat & Sun 9:30a-4p CST
Remote Hospice Triage RN providing after-hours telephone support for IntellaTriage’s hospice and home-health partners. Assessing patients, coordinating care, and documenting urgent calls.
Customer Delivery Lead
Customer Delivery Lead managing SAP HR service delivery, customer satisfaction, and profitability. SD Worx provides European payroll and HR solutions.
Home Care Worker
Part-time Home Care Worker providing domestic and personal care for Silverchain’s aged-care clients. Supporting independence, wellbeing, mobility, medication routines and community activities.
Business Resource Specialist
Business Resource Specialist analyzing data, supporting projects, and improving workflows for a major U.S. insurance and financial services provider. Creating reports, dashboards, and business insights.
Application Reader
Part-time application reader reviewing DePaul University admissions applications from home. Seasonal work concentrated October–March, with application-review training and deadline-driven assignments.
Care Connector
Care Connector resolving complex patient and member concerns for Geisinger’s Pennsylvania healthcare system. Providing clinical support, crisis triage, benefits guidance, and resource coordination from home.