Remote Utilization Review Specialist

Red Oak Recovery; Northern (KY); Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical Coverage

401(k) plan

Paid Time Off

Employee Assistance Program

Job summary

Red Oak Recovery Center is seeking a Utilization Review Coordinator to ensure medical necessity, regulatory compliance, and efficient resource use across patient care. You will review medical records and treatment plans, coordinate with providers, insurers, and case managers, and make authorization decisions while upholding high-quality patient care and cost-conscious services.

The role requires attention to detail, knowledge of payer policies, and the ability to communicate clearly with

Qualifications

• Bachelor’s degree in a healthcare or related field.
• At least 2 years of utilization review, case management, or clinical healthcare experience.
• 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 medical records, treatment plans, and clinical documentation for necessity and appropriateness.
• Coordinate with providers, insurers, and case managers to obtain information.
• Decide on authorization, continuation, modification, or denial of services based on guidelines and regulations.
• Maintain records of utilization review activities and communications in compliance with policies.
• Stay current with evolving healthcare regulations and payer policies to ensure compliant reviews.

Skills

Utilization review

Case management

Healthcare knowledge

Regulatory compliance

Analytical skills

Communication skills

Organizational skills

Education

Bachelor’s degree in healthcare or related field

Tools

Electronic Health Records (EHR)

Utilization management software

Job description

Red Oak Recovery Center is seeking a Utilization Review Coordinator to ensure medical necessity, regulatory compliance, and efficient resource use across patient care. You will review medical records and treatment plans, coordinate with providers, insurers, and case managers, and make authorization decisions while upholding high-quality patient care and cost-conscious services.

The role requires attention to detail, knowledge of payer policies, and the ability to communicate clearly with