Utilization Review Coordinator
Reports to: Utilization Review Manager
Job Category: Salaried | Exempt | Full-Time
Salary Range: $63,000-$85,000 per year (depending on experience and licensure)
Job Site: Remote
Schedule: Business hours, with potential for weekend rotation
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.
Education and Experience:
- 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.
Required Skills/Abilities:
- Strong organizational and time management skills.
- Attention to detail and accuracy.
- Ability to manage multiple tasks and deadlines.
- Clear and professional communication skills.
- Ability to work collaboratively with clinical and administrative teams.
- Problem-solving and follow-up skills.
- Familiarity with electronic health records and healthcare documentation standards.
- Proficient with Google Workspace or related software.
Duties/Responsibilities:
- Submit initial and continued stay authorization requests to insurance payors.
- Track authorization approvals, denials, and expiration dates.
- Maintain accurate and timely documentation in the electronic health record.
- Communicate authorization status to clinical and administrative staff.
- Assist with gathering clinical information for utilization reviews and audits.
- Follow up with insurance companies to ensure timely determinations.
- Support peer-to-peer reviews by coordinating required documentation and scheduling.
- Identify potential authorization issues and escalate to the Utilization Review Manager as needed.
- Ensure compliance with payor requirements, timelines, and internal policies.
- Assist with data tracking and reporting related to utilization and denials.
- Other duties as assigned.
Physical Requirements:
- Prolonged periods of sitting at a desk and working on a computer.
- Standing, sitting, bending, reaching.
- Must be able to see, hear, talk, read, write, type.
- Exposure to clinical and medical environments.
Benefits & Perks:
Health and Wellness
- Medical, dental and vision insurance*
- Supplemental accident and hospital indemnity coverage*
- Voluntary Term Life insurance*
- Employee Assistance Program
- Monthly wellness reimbursement*
Financial
- Competitive salary
- Employee recognition and rewards programs
- Employee referral incentive program
- Employer-sponsored 401(k) plan
Work/Life Perks
- Professional growth and development
- Continuing education reimbursement
- Unlimited paid time off (exempt employees) + sick days
- Paid time off policy (non-exempt employees) + sick days
- Paid holidays (exempt) or ability to earn 1.5x base hourly rate (non-exempt)
*Full-time employees
This description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
