Healthcare Utilization Review Specialist

Bradford Health Services; United States; On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical coverage

Retirement benefits

Paid time off (PTO)

Employee assistance program

Telehealth options

Job summary

Bradford Health Services is seeking a Utilization Review Coordinator to join our clinical team. The role ensures that patient services are medically necessary, efficient, and compliant with regulatory standards.

You will review patient records, treatment plans, and data to determine the appropriateness of care and resource use, collaborating with providers, insurers, and case managers to facilitate timely approvals.

Qualifications

• Bachelor’s degree in a healthcare or related field is required.
• 2+ years 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 are expected.

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, modification, or denial of services based on guidelines and requirements.
• Maintain detailed records of utilization review activities in compliance with policies and legal standards.
• Stay current with evolving healthcare regulations, payer policies, and clinical best practices.

Skills

Analytical skills

Communication

Organizational skills

Healthcare regulations

Insurance authorization

Education

Bachelor’s degree in healthcare or related field

Tools

EHR systems

Utilization management software

Job description

Bradford Health Services is seeking a Utilization Review Coordinator to join our clinical team. The role ensures that patient services are medically necessary, efficient, and compliant with regulatory standards.

You will review patient records, treatment plans, and data to determine the appropriateness of care and resource use, collaborating with providers, insurers, and case managers to facilitate timely approvals.