Utilization Review Coordinator

$55,000 - $75,000/Yr

Corporation Consulting - McKinney, TX

Full-time - Mid Level

McKinney, TX

Plastics and Rubber Products Manufacturing

About the position

The Utilization Review Coordinator will oversee the utilization review process within the organization, ensuring that medical care is effective, efficient, and adheres to evidence-based standards. This role requires strong leadership, clinical expertise, and a comprehensive understanding of healthcare utilization management principles. The coordinator will lead a team, improve processes, provide clinical guidance, and ensure compliance with regulatory standards.

Responsibilities

• Provide strong leadership and direction to the utilization review team.
• Evaluate and streamline utilization review processes for efficiency and accuracy.
• Provide clinical guidance and expertise to utilization review staff.
• Collaborate closely with healthcare providers and interdisciplinary teams.
• Develop and implement quality assurance measures for utilization review activities.
• Analyze utilization data and prepare reports for senior leadership.
• Provide ongoing training and professional development for utilization review staff.
• Ensure compliance with regulatory requirements and conduct audits.

Requirements

• Bachelor's degree in nursing or a related healthcare field is required.
• Current unrestricted registered nurse (RN) license in Texas is required.
• Minimum of 5 years of experience in healthcare utilization review or case management.
• Strong leadership and management skills.
• Excellent analytical and problem-solving skills.
• Proficiency in healthcare information systems and Microsoft Office Suite.

Nice-to-haves

• Master's degree in healthcare administration or nursing is preferred.
• Certification in case management (e.g., CCM) or utilization management (e.g., CPHQ) is preferred.

Benefits

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off