Utilization Review Clerk

Overview:

The Non-Clinical Administrator Reviewer is responsible for supporting the Utilization Review (UR) process by performing administrative and data-related tasks. This role focuses on ensuring that requests are complete, accurately documented and properly routed, without performing any clinical evaluation or interpretation of medical information.

Duties:

• Conduct initial screening of utilization review requests for completeness and accuracy of submitted information

• Ensure all assigned tasks are completed within established timelines and service level agreements.
• Coordinate and communicate with Initial Clinical Reviewers and other internal teams for case processing 
• Maintain confidentiality and comply with data privacy and security standards
• Perform other administrative duties as assigned based upon business needs 

Experience, Training, and Education:

• Graduate of a college level degree program required, preferably in a health sciences field of study 
• Previous experience in administrative support, data entry or back-office operations preferred
• Experience in Utilization Management, healthcare administration or insurance processes- preferred 
• Must be familiar with basic Microsoft Office applications, such as Word and Excel. 
• Experience should include working in fast-paced work environments. 
• Must be able to maintain confidentiality. 

Knowledge, Skills and Abilities:

Strong attention to detail with accurate typing, spelling, sentence structure, and punctuation. Capable of performing tasks with minimal supervision. Basic reading, writing, and some mathematic skills required. Strong communication and coordination skills when working in a team environment. Good organizational and time management skills. High level of integrity and ability to maintain confidentiality of sensitive information.