Utilization Review Coordinator
$63,000–$85,000 year
Remote
Job Summary
The Utilization Review Coordinator supports utilization review functions by obtaining and tracking authorizations, maintaining accurate documentation, and ensuring timely communication with payors and clinical staff. This role plays a key part in supporting continuity of care, regulatory compliance, and reimbursement for behavioral health services. Responsibilities include submitting initial and continued stay authorization requests, tracking approvals/denials/expiration dates, maintaining accurate EHR documentation, communicating authorization status to clinical and administrative staff, assisting with gathering clinical information for utilization reviews and audits, following up with insurance companies to ensure timely determinations, supporting peer-to-peer reviews by coordinating required documentation and scheduling, and ensuring payor compliance and internal policy adherence. Also assists with data tracking and reporting related to utilization and denials. Physical requirements include prolonged sitting and computer work in a clinical environment. Benefits include health/dental/vision insurance, wellness reimbursement, life insurance, EAP, 401(k), continuing education, unlimited PTO, and paid holidays. This is a full-time remote position.
Required Qualifications
- Bachelor’s degree required
- Master’s degree preferred
- Professional clinical or nursing license strongly preferred (LPC, LCSW, LMFT, LPN, RN)
- Experience in utilization review, care coordination, or healthcare administration preferred
- Behavioral health experience strongly preferred
- Knowledge of insurance authorization processes and medical necessity criteria a plus
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