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Utilization Review Coordinator

Job Overview

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Work Schedule

Day Shifts
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Benefits

Medical Coverage
Expanded coverage
mental health support
Voluntary coverages
Student loan repayment
Retirement benefits
generous PTO
Voluntary benefits for part-time employees

Job Description

Lakeview Health is a leading addiction treatment center dedicated to helping individuals detox, recover, and maintain long-term abstinence from dangerous substances. With thousands of success stories, Lakeview Health has established itself as a trusted provider in the addiction recovery field. The organization prides itself on its proven treatment programs, experienced and compassionate staff, and amenity-rich campus designed to foster healing and personal growth. Situated within a supportive and caring environment, Lakeview Health aims to offer comprehensive care tailored to meet the unique needs of each patient, ensuring they have the resources and guidance necessary to succeed in their recovery journey. Beyond traditional treatment, the facility extends its reach through a robust aftercare program, supporting alumni during their continued path to wellness and preventing relapses through ongoing community engagement and resources. This holistic approach positions Lakeview Health as a top choice for those seeking quality addiction treatment services in the United States.

We are currently seeking a Utilization Review Coordinator to join our dynamic team. This full-time role is instrumental in ensuring that the healthcare services provided to our patients are medically necessary, efficient, and compliant with relevant regulatory standards. The Utilization Review Coordinator is responsible for the detailed evaluation of patient records, treatment plans, and clinical data to determine the appropriateness of care and resource use. This role requires strong collaboration with healthcare providers, insurance companies, and case managers to facilitate timely approvals and optimize patient outcomes. By applying clinical knowledge alongside regulatory guidelines, the Utilization Review Coordinator helps control healthcare costs while maintaining the highest standards of patient care. This position offers an exceptional opportunity to contribute directly to the quality and sustainability of healthcare delivery systems nationwide. The work schedule is Monday through Friday, from 8:00 AM to 5:00 PM, within a supportive environment that values inclusion, trust, and purposeful leadership. Lakeview Health is proud to be certified as a Great Place to Work, reinforcing our commitment to nurturing a workplace culture that supports employee well-being as the foundation for excellent patient care. Individuals who join us will benefit from a comprehensive benefits package including multiple medical plan options, mental health support, voluntary coverages, student loan repayment opportunities, retirement benefits, generous paid time off, and voluntary benefits for part-time employees. This role is ideal for candidates with at least two years of clinical healthcare experience who seek a meaningful position contributing to healthcare quality and cost containment in the addiction treatment sector.

Job Requirements

  • Bachelor’s degree in a healthcare or related field
  • At least 2 years of experience in utilization review, case management, or clinical healthcare roles
  • Strong knowledge of medical terminology, clinical procedures, and healthcare regulations
  • Familiarity with insurance authorization processes and healthcare reimbursement models
  • Excellent analytical, communication, and organizational skills

Job Qualifications

  • Bachelor’s degree in a healthcare or related field
  • At least 2 years of experience in utilization review, case management, or clinical healthcare roles
  • Strong knowledge of medical terminology, clinical procedures, and healthcare regulations
  • Familiarity with insurance authorization processes and healthcare reimbursement models
  • Excellent analytical, communication, and organizational skills
  • Experience with electronic health records (EHR) systems and utilization management software
  • Certification in Utilization Review (e.g., Certified Professional in Utilization Review or Certified Case Manager)
  • Prior experience working with managed care organizations or insurance companies
  • Advanced knowledge of Medicare, Medicaid, and other payer-specific guidelines

Job Duties

  • Review and analyze medical records, treatment plans, and clinical documentation to assess the necessity and appropriateness of healthcare services
  • Coordinate with healthcare providers, insurance representatives, and case managers to obtain additional information and clarify treatment details
  • Make informed decisions regarding authorization, continuation, modification, or denial of services based on clinical guidelines and regulatory requirements
  • Maintain accurate and detailed records of utilization review activities, decisions, and communications in compliance with organizational policies and legal standards
  • Stay current with evolving healthcare regulations, payer policies, and clinical best practices to ensure consistent and compliant review processes

Job Criteria

Experience

Mid Level (3-7 years)


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