Utilization Review Specialist

A company is looking for a Specialist, Appeals and Utilization Review.

Key Responsibilities

Investigate and process intake of Organization Determinations, Appeals, and Grievances (ODAG) in a timely manner

Document and track ODAG requests, ensuring compliance with CMS guidelines

Prepare written documentation and respond to inquiries related to ODAG cases

Required Qualifications

High school diploma or GED required

Working knowledge of Medicare Advantage

Experience supporting Medicare Advantage members

Proficient in Microsoft Word and Excel

Experience interpreting regulations and applying them to case decisions