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.