Aspire Health is seeking an experienced Utilization Review Coordinator to support clinical operations through timely, accurate review of medical services. This remote position plays a critical role in ensuring care delivery aligns with established medical necessity criteria, payer requirements, and regulatory standards.
The ideal candidate is detail-oriented, analytical, and experienced in utilization management within a healthcare environment.
Conduct utilization review activities including prior authorizations, concurrent reviews, and retrospective reviews
Evaluate clinical documentation for medical necessity and appropriateness of care
Apply payer guidelines, CMS regulations, and organizational policies consistently
Coordinate with providers, health plans, and internal clinical teams to obtain required documentation
Document review outcomes clearly and accurately in utilization management systems
Identify potential care delays or gaps and escalate as appropriate
Support quality assurance, compliance, and process improvement initiatives
Minimum of 1 year of experience in utilization review, utilization management, or related healthcare role
Knowledge of medical necessity criteria and payer authorization processes
Strong analytical, organizational, and documentation skills
Excellent written and verbal communication abilities
Ability to work independently and manage multiple priorities in a remote environment
Proficiency with electronic medical records and utilization management platforms
Clinical background (RN, LPN, LVN, or allied health professional)
Experience with Medicare Advantage, Medicaid, or commercial insurance plans
Familiarity with InterQual, MCG, or comparable utilization review guidelines
Prior experience in a remote or virtual healthcare setting
Competitive compensation commensurate with experience
Comprehensive benefits package including medical, dental, and vision coverage
Paid time off and paid holidays
Opportunities for professional development and advancement
Supportive, collaborative remote work environment
In this role, your work ensures patients receive the right care at the right time—without unnecessary delays. Youll be a trusted partner to providers and a key contributor to Aspire Healths mission of accessible, high-quality care.
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