Job Description
Position Summary
Aspire Health is seeking an experienced Utilization Review Coordinator to support clinical operations through timely, accurate review of medical services. This remote position plays a critical role in ensuring care delivery aligns with established medical necessity criteria, payer requirements, and regulatory standards.
The ideal candidate is detail-oriented, analytical, and experienced in utilization management within a healthcare environment.
Key Responsibilities
- Conduct utilization review activities including prior authorizations, concurrent reviews, and retrospective reviews
- Evaluate clinical documentation for medical necessity and appropriateness of care
- Apply payer guidelines, CMS regulations, and organizational policies consistently
- Coordinate with providers, health plans, and internal clinical teams to obtain required documentation
- Document review outcomes clearly and accurately in utilization management systems
- Identify potential care delays or gaps and escalate as appropriate
- Support quality assurance, compliance, and process improvement initiatives
Required Qualifications
- Minimum of 1 year of experience in utilization review, utilization management, or related healthcare role
- Knowledge of medical necessity criteria and payer authorization processes
- Strong analytical, organizational, and documentation skills
- Excellent written and verbal communication abilities
- Ability to work independently and manage multiple priorities in a remote environment
- Proficiency with electronic medical records and utilization management platforms
Preferred Qualifications (But Not Required)
- Clinical background (RN, LPN, LVN, or allied health professional)
- Experience with Medicare Advantage, Medicaid, or commercial insurance plans
- Familiarity with InterQual, MCG, or comparable utilization review guidelines
- Prior experience in a remote or virtual healthcare setting
Compensation & Benefits
- Competitive compensation commensurate with experience
- Comprehensive benefits package including medical, dental, and vision coverage
- Paid time off and paid holidays
- Opportunities for professional development and advancement
- Supportive, collaborative remote work environment
Your Impact
In this role, your work ensures patients receive the right care at the right time—without unnecessary delays. Youll be a trusted partner to providers and a key contributor to Aspire Healths mission of accessible, high-quality care.
Job Tags
Remote work,