Utilization Review Coordinator

Utilization Review Coordinator

Our Story

Imagine being part of a team that’s not just shaping the future but actively driving it. At Davies North America, we’re at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors.

What’s in Store 

We're on the lookout for a Utilization Review Coordinator to join our growing team! As a Utilization Review Coordinator, you will provide Utilization Review administrative assistance to nurses and provide clerical support per guidelines for Initial Requests for referrals for PT, diagnostics and specialists. You may also be required to cross train in all other office admin positions, such as Case Management Assistant and Triage. Other responsibilities and duties include:

• Follow workflow expected of UR Coordinator according to company and client protocols and production standards:
  1. eFax received with request
  2. Request researched for duplicate and sufficient information
  3. Request logged as received with date and reviewer date
  4. Requests issued to UR nurse
  5. Sorted per ‘precert’ or ‘non-precert’ protocol
  6. Requests with lack of information, clinical information requested x 3
  7. Turn-around time expected within 24 hours
• Follow Rapid Response protocol established by client to authorize initial PT, initial diagnostics and initial referrals to a specialist upon receipt of referral on all new claims
• Document initial actions in Corrus using correct grammar, spelling, and sentence structure
• May act as back-up assistance for Triage Department and CMA Department
• Perform other duties as needed

This role is a full-time, remote position.

Your Expertise, Skills, and Abilities

• High school diploma or equivalent
• A minimum of one year of medical terminology/medical office experience
• Maintain working knowledge of appropriate state’s Workers’ Compensation system and the statutes
• Proactive, independent, and takes initiative with consistent follow through
• Superb written and verbal communication skills conducted in a timely manner
• Superior time management skills with capability of working with and meeting deadlines
• Exceptional capability to multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environment
• Excellent team player with interpersonal skills
• High level attention to detail and problem-solving skills
• Capable of working collaboratively and independently with minimal supervision
• Exhibit discretion with sensitive and confidential information

Benefits

At Davies North America, we are dedicated to supporting the well-being and future of our qualifying employees. Our comprehensive benefits package includes:

• Medical, dental, and vision plans to ensure your health and that of your family
• A 401k plan with employer matching to help you build a secure financial future
• Our time-off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment
• Paid holidays
• Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones

Diversity and Inclusion

Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We believe that diversity of thought is essential for innovation and creativity, and we actively promote an environment where all voices are valued and heard.

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