Utilization Review Coordinator (Remote)

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. Your Impact: 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.

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