Utilization Review Specialist

ABOUT US:

Ethos Risk Services is a leading insurance claims investigation and medical management company committed to providing better data that translates into better decision-making for our clients. We are at the forefront of innovation in our space, and our success is driven by a dynamic team passionate about delivering exceptional services to our customers.

JOB SUMMARY:

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.

KEY 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.

QUALIFICATIONS:

Education: High school diploma or equivalent required.

Experience:

• Minimum of 1 year in a healthcare-related setting (required).
• Knowledge of HIPAA rules and regulations required.
• Prior experience in utilization review, medical management, or insurance preferred.

Skills:

• 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.

WORKING CONDITIONS:

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.

Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristic.