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:
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Bachelor’s degree required, Master’s degree preferred.
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Professional clinical or nursing license strongly preferred (LPC, LCSW, LMFT, LPN, RN).
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Experience in utilization review, care coordination, or healthcare administration preferred.
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Behavioral health experience strongly preferred.
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Knowledge of insurance authorization processes and medical necessity criteria a plus.
Required Skills/Abilities:
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Strong organizational and time management skills.
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Attention to detail and accuracy.
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Ability to manage multiple tasks and deadlines.
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Clear and professional communication skills.
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Ability to work collaboratively with clinical and administrative teams.
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Problem-solving and follow-up skills.
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Familiarity with electronic health records and healthcare documentation standards.
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Proficient with Google Workspace or related software.
Duties/Responsibilities:
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Submit initial and continued stay authorization requests to insurance payors.
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Track authorization approvals, denials, and expiration dates.
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Maintain accurate and timely documentation in the electronic health record.
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Communicate authorization status to clinical and administrative staff.
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Assist with gathering clinical information for utilization reviews and audits.
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Follow up with insurance companies to ensure timely determinations.
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Support peer-to-peer reviews by coordinating required documentation and scheduling.
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Identify potential authorization issues and escalate to the Utilization Review Manager as needed.
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Ensure compliance with payor requirements, timelines, and internal policies.
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Assist with data tracking and reporting related to utilization and denials.
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Other duties as assigned.
Physical Requirements:
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Prolonged periods of sitting at a desk and working on a computer.
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Standing, sitting, bending, reaching.
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Must be able to see, hear, talk, read, write, type.
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Exposure to clinical and medical environments.
Benefits & Perks:
Health and Wellness
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Medical, dental and vision insurance*
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Supplemental accident and hospital indemnity coverage*
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Voluntary Term Life insurance*
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Employee Assistance Program
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Monthly wellness reimbursement*
Financial
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Competitive salary
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Employee recognition and rewards programs
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Employee referral incentive program
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Employer-sponsored 401(k) plan
Work/Life Perks
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Professional growth and development
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Continuing education reimbursement
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Unlimited paid time off (exempt employees) + sick days
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Paid time off policy (non-exempt employees) + sick days
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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.
