Impactful Utilization Review Specialist

Sunshine Behavioral Health; Washington; On-site; USD 55,000 - 65,000; Full time

Job summary

Sunshine Behavioral Health in Washington state is seeking a full-time Utilization Review Coordinator to manage authorization processes for treatment services. You will collaborate with clinicians and insurers to obtain necessary approvals, review admissions, and support compliant care delivery.

The role requires knowledge of medical terminology, ASAM criteria, and ICD-10 coding, with strong Excel/Word proficiency and meticulous attention to detail.

Qualifications

• Two years of Utilization Review experience.
• Basic HIPAA knowledge.
• Proficiency with Excel, Word and electronic charting.
• Ability to communicate clearly with staff and payers.

Responsibilities

• Complete assessments and pre-certifications for clients.
• Communicate information to staff in a timely manner.
• Demonstrate knowledge of medical terminology and policy details.
• Interpret EOBs and address billing or claims issues.
• Utilize Excel, Word, and electronic charting daily.
• Maintain HIPAA, privacy and confidentiality standards.
• Participate in Quality Improvement activities.

Skills

Communication skills

Detail oriented

Problem solving

Ability to work with minimal superv.

Tools

Excel

Word

Electronic charting

Job description

Sunshine Behavioral Health in Washington state is seeking a full-time Utilization Review Coordinator to manage authorization processes for treatment services. You will collaborate with clinicians and insurers to obtain necessary approvals, review admissions, and support compliant care delivery.

The role requires knowledge of medical terminology, ASAM criteria, and ICD-10 coding, with strong Excel/Word proficiency and meticulous attention to detail.