Job Description
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Sr. Virtual Utilization Review Specialist in United States.
This role plays a critical part in ensuring appropriate healthcare utilization and optimizing patient outcomes within a fast-paced, data-informed clinical environment. The Sr. Virtual Utilization Review Specialist evaluates medical necessity, supports care coordination, and helps ensure that patients receive the right level of care at the right time. Working remotely, the role collaborates closely with physicians, care managers, financial teams, and payers to support both clinical quality and revenue integrity. It requires strong clinical judgment, analytical thinking, and the ability to interpret complex clinical criteria and payer guidelines. The position also involves contributing to denial prevention and appeals processes while maintaining compliance with regulatory standards. Ideal candidates thrive in autonomous settings while staying highly connected to multidisciplinary teams focused on improving patient and system-wide outcomes.
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Sr. Virtual Utilization Review Specialist in United States.
This role plays a critical part in ensuring appropriate healthcare utilization and optimizing patient outcomes within a fast-paced, data-informed clinical environment. The Sr. Virtual Utilization Review Specialist evaluates medical necessity, supports care coordination, and helps ensure that patients receive the right level of care at the right time. Working remotely, the role collaborates closely with physicians, care managers, financial teams, and payers to support both clinical quality and revenue integrity. It requires strong clinical judgment, analytical thinking, and the ability to interpret complex clinical criteria and payer guidelines. The position also involves contributing to denial prevention and appeals processes while maintaining compliance with regulatory standards. Ideal candidates thrive in autonomous settings while staying highly connected to multidisciplinary teams focused on improving patient and system-wide outcomes.