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 timewithout 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,

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