Utilization Review Coordinator
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Job Location:
Jacksonville, FL - USA
Monthly Salary:
Not Disclosed
Posted on:
16 hours ago
Vacancies:
1 Vacancy
Job Summary
Position Summary
Aspire Health is seeking an experienced Utilization Review Coordinator to support clinical operations through timely accurate review of medical services. This remote position plays a critical role in ensuring care delivery aligns with established medical necessity criteria payer requirements and regulatory standards.
The ideal candidate is detail-oriented analytical and experienced in utilization management within a healthcare environment.
Key Responsibilities
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Conduct utilization review activities including prior authorizations concurrent reviews and retrospective reviews
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Evaluate clinical documentation for medical necessity and appropriateness of care
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Apply payer guidelines CMS regulations and organizational policies consistently
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Coordinate with providers health plans and internal clinical teams to obtain required documentation
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Document review outcomes clearly and accurately in utilization management systems
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Identify potential care delays or gaps and escalate as appropriate
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Support quality assurance compliance and process improvement initiatives
Required Qualifications
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Minimum of 1 year of experience in utilization review utilization management or related healthcare role
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Knowledge of medical necessity criteria and payer authorization processes
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Strong analytical organizational and documentation skills
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Excellent written and verbal communication abilities
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Ability to work independently and manage multiple priorities in a remote environment
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Proficiency with electronic medical records and utilization management platforms
Preferred Qualifications (But Not Required)
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Clinical background (RN LPN LVN or allied health professional)
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Experience with Medicare Advantage Medicaid or commercial insurance plans
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Familiarity with InterQual MCG or comparable utilization review guidelines
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Prior experience in a remote or virtual healthcare setting
Compensation & Benefits
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Competitive compensation commensurate with experience
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Comprehensive benefits package including medical dental and vision coverage
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Paid time off and paid holidays
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Opportunities for professional development and advancement
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Supportive collaborative remote work environment
Your Impact
In this role your work ensures patients receive the right care at the right timewithout unnecessary delays. Youll be a trusted partner to providers and a key contributor to Aspire Healths mission of accessible high-quality care.
Key Skills
- Corporate Risk Management
- Electronics
- Infection Control
- Bakery
- ELV
- Accident Investigation
