Responsibilities

The Utilization Review/Utilization Management (UR/UM) Specialist is responsible for reviewing medical services for appropriateness, medical necessity, and efficiency. This role ensures that patient care aligns with established guidelines and payer policies while optimizing resource utilization. The specialist collaborates with healthcare providers, insurance companies, and case management teams to facilitate timely authorizations and appeals when necessary.

Qualifications

Education:

• Associate's or Bachelor's degree in Radiation Therapy, Health Administration, or a related field preferred; 2-5 years oncology experience; utilization review or prior authorization experience required.

Experience:

• 2-5 years in utilization review, case management, or prior authorization, preferably in a hospital or managed care setting.
• Strong understanding of medical nec...