Utilization Review Coordinator

Utilization Review Coordinator

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Reporting To: Karen Kowatch

Compensation: $18.00 - $20.00 / hour

Description

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.

We are looking for a Utilization Review Coordinator to provide Utilization Review administrative assistance to nurses, along with providing clerical support per guidelines for Initial Requests for referrals for specialists.


Key Responsibilities

• Follow workflow expected of UR Coordinator according to company and client protocols and production standards:
• Coordinate scheduling of specialist referrals that have been approved by the UR Specialists.
• 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.

Skills, knowledge & expertise

• High school diploma.
• A minimum of one year of medical terminology/medical office experience.
• Have a working knowledge of appropriate state's Workers' Compensation system and the statutes.
• Medical terminology knowledge.
• Experience dealing with medical provider offices.
• Data entry proficiency and computer skills -Word, Excel.
• Excellent organizational skills.
• Detail orientated and motivated.
• Ability to work in fast-paced environment and utilize critical thinking skills to ensure proactive outcomes.
• Ability to effectively operate a personal computer and related claims and business software.
• Good communication skills, both oral and written.
• Team player.
• Good attendance.
• Good customer service skills.

Equal Employment Opportunity & Legal Notices

Benefits

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

• Medical, dental, and vision plans to support your health and that of your family
• A 401(k) plan with employer matching
• Timeoff policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for nonexempt employees
• Paid holidays
• Life insurance and shortterm and longterm disability coverage

Benefit offerings, eligibility, and required employer contributions may vary based on role, classification, and applicable federal, state, and local laws, including those tied to an employee's primary work location.

Where required by law, the Company provides paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements.

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.

Compensation Transparency:
The salary range listed reflects the full compensation band for this role across all locations. Actual compensation will be based on factors such as skills, experience, qualifications, and geographic location, which may impact the final offer. We share ranges to remain transparent and consistent with pay equity practices.


Background Check & Fair Chance Compliance

Any background check or review of criminal history, if applicable to the role, will be conducted only after a conditional offer of employment and in compliance with applicable federal, state, and local laws, including fairchance hiring requirements.

Massachusetts Notice It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

We do not use sites like Facebook, Craigslist, or Telegram to recruit or interview potential employees or contractors. If you have been asked to provide any information through any method other than our career portal, please email us at View email address on click.appcast.io