Clinical Utilization Review Specialist

Bradford Health Services; Birmingham (AL); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Medical coverage

Dependent coverage

Mental health support

Pet insurance

Student loan repayment

Retirement plan

Generous PTO

Voluntary benefits for PT

Job summary

Bradford Health Services seeks a skilled Utilization Review Specialist to ensure medical necessity and efficient resource use across our care network. You will evaluate patient records and treatment plans, collaborating with providers and insurers to secure appropriate approvals.

The role emphasizes regulatory compliance, documentation accuracy, and cost containment while supporting high-quality patient care. A collaborative, mission-driven environment awaits.

Qualifications

• Bachelor’s degree in Nursing, Health Administration, or a related healthcare field.
• 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 utilization management guidelines.
• Excellent communication and analytical skills with attention to detail.

Responsibilities

• Review and analyze medical records, treatment plans, and clinical documentation to assess necessity and appropriateness of services.
• Coordinate with healthcare providers, insurance representatives, and case managers to obtain information and clarify treatment details.
• Make informed decisions regarding authorization, continuation, or denial of services based on guidelines and regulatory requirements.
• Document findings and decisions in electronic health record systems and prepare detailed reports for stakeholders.
• Stay current with healthcare regulations, insurance policies, and best practices to ensure compliance and effective utilization management.

Skills

Communication

Analytical thinking

Attention to detail

Regulatory knowledge

Clinical documentation

Education

Bachelor’s degree in Nursing, Health Administration, or related healthcare field

Tools

Electronic Health Records (EHR)

Utilization review software

Job description

Bradford Health Services seeks a skilled Utilization Review Specialist to ensure medical necessity and efficient resource use across our care network. You will evaluate patient records and treatment plans, collaborating with providers and insurers to secure appropriate approvals.

The role emphasizes regulatory compliance, documentation accuracy, and cost containment while supporting high-quality patient care. A collaborative, mission-driven environment awaits.