Healthcare Utilization Review Analyst

ADP, Inc.; Southaven (MS); On-site; USD 65,000 - 85,000; Full time

Job summary

Bradford Health Services is seeking a Utilization Review Specialist to ensure medical necessity and regulatory compliance across U.S. healthcare services.

The role analyzes patient records and treatment plans, collaborating with providers, insurers, and case managers to secure timely approvals and optimize outcomes. Minimum qualifications include a Bachelor's degree in a healthcare field and at least 2 years in utilization review or related roles, with strong medical terminology knowledge and

Qualifications

• 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.

Responsibilities

• Review and analyze medical records to assess necessity and appropriateness of services.
• Coordinate with providers, insurers, and case managers to obtain information.
• Make decisions on authorization, continuation, modification, or denial of services.
• Maintain accurate records of utilization review activities in compliance with policies.
• Stay current with evolving healthcare regulations and payer policies.

Skills

Analytical skills

Communication skills

Organizational skills

Medical terminology knowledge

Education

Bachelor's degree in healthcare or related field

Tools

Electronic Health Records (EHR)

Utilization management software

Job description

Bradford Health Services is seeking a Utilization Review Specialist to ensure medical necessity and regulatory compliance across U.S. healthcare services.

The role analyzes patient records and treatment plans, collaborating with providers, insurers, and case managers to secure timely approvals and optimize outcomes. Minimum qualifications include a Bachelor's degree in a healthcare field and at least 2 years in utilization review or related roles, with strong medical terminology knowledge and