Utilization Review Coordinator

Job Description

As a Utilization Review Coordinator, you will play a vital role in assessing the quality and appropriateness of healthcare services. Your primary responsibilities will include evaluating patient records, collaborating with healthcare providers, and optimising care pathways to ensure our patients receive the best services possible.

Responsibilities

• Assess treatment plans for adherence to medical necessity criteria.
• Coordinate with insurance companies to facilitate prior authorizations.
• Develop protocols to streamline the review process.
• Facilitate staff training on utilization review guidelines.
• Collaborate with cross-functional teams to enhance patient care.
• Document all review processes for audit and compliance purposes.

Requirements

Education

• Master's degree in healthcare administration, nursing, or a related field is preferred

Experience

• Experience in healthcare quality improvement and utilization review is advantageous

Technical Skills

• Statistical Analysis Software

Soft Skills

• Attention to Detail

Certifications

• Lean Six Sigma Certification

Languages

• English: Fluent

Advantageous

• Certification in healthcare quality or utilization review: Professional certifications enhancing credentials.

Benefits

• Annual performance bonuses and merit increases.
• Employee wellness programmes and resources.
• Training and professional development funding.
• Generous leave policies including sick leave and parental leave.

Company Culture

• Innovation: Encouraging innovative thinking to improve patient care and outcomes.
• Growth Opportunities: Focused on providing growth opportunities through mentorship and training.