Utilization Review Coordinator

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🇺🇸 United States – Remote

💵 $55k - $75k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

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Red Oak Recovery

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2014

🏥 Healthcare

Healthcare • Mental Health • Addiction Treatment

Red Oak Recovery is a specialized addiction treatment center focused exclusively on men, located in the serene Blue Ridge Mountains. The facility offers a comprehensive range of evidence-based therapies alongside experiential treatments to address various substance abuse issues, co-occurring mental health conditions, and emotional challenges. With a mission to foster healing and recovery, Red Oak Recovery provides a supportive environment where clients can embark on a transformative journey towards sobriety and personal growth.

📋 Description

• Review and analyze medical records, treatment plans, and clinical documentation to assess the necessity and appropriateness of healthcare services • Coordinate with healthcare providers, insurance representatives, and case managers to obtain additional information and clarify treatment details • Make decisions regarding authorization, continuation, modification, or denial of services based on clinical guidelines and regulatory requirements • Maintain accurate and detailed records of utilization review activities, decisions, and communications in compliance with organizational policies and legal standards • Stay current with evolving healthcare regulations, payer policies, and clinical best practices • Facilitate timely approvals and optimize patient outcomes • Help control healthcare costs while maintaining high-quality patient care

🎯 Requirements

• Bachelor’s degree in a healthcare or related field • At least 2 years of experience 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 • Experience with electronic health records (EHR) systems and utilization management software preferred • Certification in Utilization Review (e.g., Certified Professional in Utilization Review or Certified Case Manager) preferred • Prior experience working with managed care organizations or insurance companies preferred • Advanced knowledge of Medicare, Medicaid, and other payer-specific guidelines preferred • Monday–Friday availability, 8:00 AM–5:00 PM

🏖️ Benefits

• Medical Coverage – Three new BCBSAL medical plans with better rates, improved co-pays, and enhanced prescription benefits • Expanded Coverage – Options for domestic partners and a wider network of in-network providers • Mental Health Support – Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching • Voluntary Coverages – Pet insurance, home and auto insurance, family legal services, and more • Student Loan Repayment – Available for nurses and therapists • Retirement Benefits – 401(k) plan through Voya • Generous PTO – A robust paid time off policy • Voluntary Benefits for Part-Time Employees – Dental, vision, life, accident insurance, and telehealth options for those working 20 hours or more per week • Great Place to Work® Certification and supportive workplace culture