Utilization Review Coordinator

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