[Hiring] Utilization Review Specialist @Ethos Risk Services

Role Description

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
• Delivering exceptional client service through phone and email communication

Qualifications

• High school diploma or equivalent required
• 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
• 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

Requirements

• 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

Working Conditions

• This position is 100% remote
• Standard business hours of 8:00 AM to 5:00 PM Pacific Standard Time (PST)
• Must be able to adjust schedule to align with PST hours
• Occasional flexibility to start earlier or work later as needed
• Dedicated workspace with reliable high-speed internet required
• Role involves extended periods of sitting, frequent computer use, and regular communication via phone, email, and other digital platforms

Company Description

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.