Utilization Review Specialist

A company is looking for a Utilization Review Specialist.

Key Responsibilities

Review and process Independent Review (IR) requests for potential conflicts of interest

Request and organize additional medical documentation for Physician Advisors

Ensure all work meets Client, State, Federal, and URAC compliance standards

Qualifications

High school diploma or equivalent required

Minimum of 1 year in a healthcare-related setting required

Knowledge of HIPAA rules and regulations required

Prior experience in utilization review, medical management, or insurance preferred