Utilization Review Specialist

Ethos Risk Services • Las Vegas, NV

1d • Remote

About The Position

Our Ethos Medical Management Team is seeking a full-time Utilization Review Specialist (REMOTE) to play a key role in ensuring the efficient, accurate, and timely processing of Utilization Management and Independent Review requests for our clients. This role involves reviewing case requests, maintaining compliance with applicable regulations, supporting Physician Advisors with case materials and scheduling, and delivering exceptional client service through phone and email communication.

Requirements

• High school diploma or equivalent required.
• Minimum of 1 year in a healthcare-related setting (required).
• Knowledge of HIPAA rules and regulations required.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
• Excellent written and verbal communication skills.
• Strong attention to detail and organizational abilities.
• Customer service mindset with professional phone etiquette.
• This position is 100% remote , requiring standard business hours of 8:00 AM to 5:00 PM Pacific Standard Time (PST) . If you're located in another time zone, you must be able to adjust your schedule to align with PST hours, including occasional flexibility to start earlier or work later as needed.
• Candidates should have a dedicated workspace with reliable high-speed internet.
• The role involves extended periods of sitting, frequent computer use, and regular communication via phone, email, and other digital platforms.

Nice To Haves

• Prior experience in utilization review, medical management, or insurance preferred.

Responsibilities

• Review and process Independent Review (IR) requests for potential conflicts of interest.
• Request and organize additional medical documentation for Physician Advisors.
• Schedule peer-to-peer calls as needed.
• Ensure all work meets Client, State, Federal, and URAC compliance standards.
• Maintain the security and confidentiality of Protected Health Information (PHI).
• Provide timely, professional client service via phone and email.
• Adhere to company policies, procedures, and turnaround time expectations.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED