Utilization Review Coordinator

Long Tail Health Solutions Inc. provides technology-enabled services for healthcare providers. The Utilization Review Coordinator manages clinical review submissions, payer communications, documentation, compliance, and workflow improvements while supporting clients and collaborating with utilization nurses and other team members.

Responsibilities

• Coordination: Manage and track the submission of clinical reviews to payers, ensuring deadlines and requirements are met
• Payer Communication: Act as the primary liaison with payers to address and resolve any issues related to utilization reviews
• Documentation: Ensure that clinical documentation and review requests are accurate, complete, and compliant with payer guidelines
• Team Support: Collaborate with utilization nurses and other team members to ensure seamless operations
• Compliance: Maintain knowledge of payer guidelines and healthcare regulations to ensure all activities meet compliance standards
• Process Improvement: Identify and implement opportunities to streamline UR workflows and improve operational efficiency
• Client Service: Provide exceptional service to clients by addressing inquiries, resolving issues, and ensuring satisfaction with UR operations

Preferred

• Associate's degree or certification in a healthcare-related field
• Bachelor's degree in healthcare administration, nursing, or a related field
• Associate’s Degree
• Healthcare-Related Certification
• Bachelor’s Degree
• Healthcare Administration
• Nursing

Benefits

• Remote work environment

Company

• Healthcare operations services reducing denials and improving revenue recovery
• Chicago, Illinois, USA
• https://www.longtailhealth.com/
• Founded in 2023
• 51-200 employees

Qualifications

• High school diploma or equivalent
• 2+ years of experience in Utilization Review, case management, or a similar healthcare operations role
• Knowledge of Utilization Review processes and payer requirements
• Familiarity with healthcare systems, electronic medical records (EMR), and clinical documentation standards
• Understanding of healthcare regulations, including Medicare and Medicaid guidelines
• Strong organizational skills to manage multiple tasks and meet tight deadlines
• Excellent written and verbal communication skills for professional interactions with clinical staff, payers, and clients
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) and familiarity with UR-related software
• Attention to detail to ensure the accuracy of documentation and review submissions
• Ability to work independently while collaborating effectively within a remote team environment
• Associate's degree or certification in a healthcare-related field
• Bachelor's degree in healthcare administration, nursing, or a related field
• 2+ years of experience in Utilization Review, case management, or a similar healthcare operations role.

Required skills

• Clinical Documentation Standards, Medicare and Medicaid Guidelines, Payer Requirements, Utilization Review Processes

Experience

• 2+ years