Care Utilization & Authorization Specialist

Socket.dev; Henderson (NV); On-site; USD 33,000 - 34,000; Full time

Job summary

WestCare in Henderson, NV is seeking a full-time Utilization Review professional to advocate for appropriate levels of care by collaborating with MCOs and providers. The role emphasizes accurate documentation, case assessment, and timely communication with insurance payors.

The position requires an associates or bachelor's level nursing or addiction credentials with 2 years of utilization review experience, plus knowledge of CPT/ICD coding and HIPAA guidelines. Strong communication is essential.

Qualifications

• Verbal and written communication skills required for coordination with providers, patients, and payors.
• High attention to detail and ability to manage multiple case files.
• Experience with CPT, ICD-9/10 coding and medical terminology.
• Proficiency with EMR/CDS systems and HIPAA regulations.

Responsibilities

• Establish and maintain communication with insurance carriers.
• Review patient charts and disseminate clinical recommendations to payors.
• Call in intakes and obtain appropriate level of care authorizations.
• Enter authorization data accurately into systems and submit documentation.

Skills

Verbal communication

Written communication

Collaboration

Critical thinking

Attention to detail

Education

Associates or Bachelors in LPN/RN or CADC/LADC

Tools

Microsoft Office

EMR/CDS Systems

HIPAA knowledge

Job description

WestCare in Henderson, NV is seeking a full-time Utilization Review professional to advocate for appropriate levels of care by collaborating with MCOs and providers. The role emphasizes accurate documentation, case assessment, and timely communication with insurance payors.

The position requires an associates or bachelor's level nursing or addiction credentials with 2 years of utilization review experience, plus knowledge of CPT/ICD coding and HIPAA guidelines. Strong communication is essential.