Healthcare Utilization Review Specialist

Guidelight Health; United States; Remote; USD 27,552 - 41,328; Full time

Benefits offered by this job

Medical, dental, vision insurance

401(k) with company match

$1,500 tuition reimbursement

Job summary

A behavioral healthcare organization is seeking a Utilization Review Specialist to conduct clinical auditing and negotiate authorizations. The ideal candidate has a Bachelor's degree in Social Work or Nursing and 1-2 years of healthcare experience. Responsibilities include conducting live reviews, coordinating with clinical teams, and ensuring compliance with regulations. The position offers a pay range of $20 - $30 USD, along with comprehensive benefits including medical, dental, and professional development opportunities.

Qualifications

• 1-2 years of experience in healthcare in utilization review or clinical care.
• Expert understanding of patient documentation and chart auditing.
• Proficient in applicable software systems.

Responsibilities

• Conduct utilization reviews and negotiate authorizations with payors.
• Coordinate with clinical teams for coverage guidance.
• Document authorization processes in KIPU/Avea.

Skills

Utilization Review

Clinical Auditing

Data Entry

Communication Skills

Analytical Skills

Education

Bachelor's degree in Social Work, Nursing, or related field

Tools

MS Office

KIPU/Avea

Job description

A behavioral healthcare organization is seeking a Utilization Review Specialist to conduct clinical auditing and negotiate authorizations. The ideal candidate has a Bachelor's degree in Social Work or Nursing and 1-2 years of healthcare experience. Responsibilities include conducting live reviews, coordinating with clinical teams, and ensuring compliance with regulations. The position offers a pay range of $20 - $30 USD, along with comprehensive benefits including medical, dental, and professional development opportunities.