Utilization Review Coordinator

Job not on LinkedIn

🔥 1 hour ago

🇺🇸 United States – Remote

💵 $40k - $62k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

LightHouse (LTHS) Studio

WebsiteLinkedInAll Job Openings

1 - 10 employees

🥽 AR/VR

🎮 Gaming

📱 Media

AR/VR • Gaming • Media

LightHouse (LTHS) Studio is an art studio specializing in 3D animation and modeling, VFX, and rendering. The studio focuses on asset creation and video production for games and commercials, incorporating AR/VR technology and innovative digital design. They are pioneers in Web 3. 0 and Metaverse projects, renowned for their cutting-edge approach and consistent high-quality delivery, serving notable brands like McDonald's, Starbucks, GAP, and Papa John's.

📋 Description

• Manage and track the submission of clinical reviews to payers, ensuring deadlines and requirements are met • Act as the primary liaison with payers to address and resolve issues related to utilization reviews • Ensure clinical documentation and review requests are accurate, complete, and compliant with payer guidelines • Collaborate with utilization nurses and other team members to ensure seamless operations • Maintain knowledge of payer guidelines and healthcare regulations to ensure compliance • Identify and implement opportunities to streamline UR workflows and improve operational efficiency • Address client inquiries, resolve issues, and ensure satisfaction with UR operations

🎯 Requirements

• High school diploma or equivalent • Associate’s degree or certification in a healthcare-related field preferred • Bachelor’s degree in healthcare administration, nursing, or a related field preferred • 2+ years of experience in Utilization Review, case management, or a similar healthcare operations role • Knowledge of Utilization Review processes and payer requirements • Familiarity with healthcare systems, electronic medical records (EMR), and clinical documentation standards • Understanding of healthcare regulations, including Medicare and Medicaid guidelines • Strong organizational skills to manage multiple tasks and meet tight deadlines • Excellent written and verbal communication skills for professional interactions with clinical staff, payers, and clients • Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) and familiarity with UR-related software • Attention to detail to ensure the accuracy of documentation and review submissions • Ability to work independently while collaborating effectively within a remote team environment • Consistent, reliable communication with team members and stakeholders

🏖️ Benefits

• Remote work environment • Occasional travel for team meetings or client-related events

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume