Healthcare Utilization Review Specialist

Sedgwick; Florida; Hybrid; USD 25,000 - 28,000; Full time

Benefits offered by this job

Tuition reimbursement eligible.

401K plan that matches 50% on every $你

4 weeks PTO your first full year.

Job summary

Sedgwick in Florida is seeking an Utilization Review Coordinator to support clinical staff by assigning UR requests, verifying data, and entering information into the appropriate systems. This role emphasizes accuracy, teamwork, and timely processing in a busy healthcare environment.

Ideal candidates bring at least two years of admin experience in medical settings, familiarity with ICD9/CPT terminology, and strong communication skills.

Qualifications

• High School diploma or GED required.
• Two (2) years of administrative experience or equivalent combination of experience and education required. Customer service in medical field preferred.
• Knowledge of medical and insurance terminology; ICD9 and CPT coding.
• Excellent oral and written communication, including presentation skills.
• PC literate; Microsoft Office products; data entry and accuracy focus.

Responsibilities

• Accesses, triages and assigns cases for utilization review (UR).
• Responds to telephone inquiries providing accurate information and triage as necessary.
• Enters demographics and UR information into claims or clinical management system; maintains data integrity.
• Obtains all necessary information required for UR processing from internal and external sources per policies and procedures.
• Distributes incoming and outgoing correspondence, faxes and mail; uploads review documents into paperless system as necessary.
• Supports other units as needed.

Skills

Medical terminology

ICD9/CPT coding

Oral and written communication

Analytical skills

Organizational skills

Detail oriented

Interpersonal skills

Team work

Performance competencies

Microsoft Office

Education

High School diploma or GED

Tools

Microsoft Office

Clinical management system

Job description

Sedgwick in Florida is seeking an Utilization Review Coordinator to support clinical staff by assigning UR requests, verifying data, and entering information into the appropriate systems. This role emphasizes accuracy, teamwork, and timely processing in a busy healthcare environment.

Ideal candidates bring at least two years of admin experience in medical settings, familiarity with ICD9/CPT terminology, and strong communication skills.