UR Coordinator

Arch Vista is seeking a detail-oriented and organized Utilization Review (UR) Coordinator to support the utilization management process and ensure timely, accurate coordination of clinical reviews. The UR Coordinator works closely with clinical staff, providers, health plans, and internal departments to facilitate authorization requests, obtain required documentation, track review status, and support efficient patient care.

The ideal candidate has strong communication and organizational skills, understands healthcare workflows, and is comfortable managing multiple time-sensitive requests while maintaining confidentiality and regulatory compliance.

Key Responsibilities

• Coordinate and track utilization review and prior authorization requests.
• Receive, verify, and organize clinical and administrative documentation required for reviews.
• Enter and maintain accurate patient and authorization information in applicable systems.
• Monitor authorization requests and follow up on outstanding clinical documentation or decisions.
• Communicate with providers, payers, clinical reviewers, and internal departments regarding review status and requirements.
• Route cases to appropriate clinical staff for review when clinical determination is required.
• Assist with obtaining medical records and other supporting documentation.
• Maintain accurate logs, reports, and documentation related to utilization management activities.
• Identify missing or incomplete information and work proactively to resolve discrepancies.
• Support timely completion of reviews in accordance with organizational policies, payer requirements, and applicable regulations.
• Escalate urgent, complex, or potentially delayed cases to the appropriate team member.
• Maintain patient confidentiality and comply with HIPAA and organizational privacy policies.
• Participate in quality improvement initiatives and other departmental projects as assigned.

Qualifications

• High school diploma or equivalent required; associate degree or healthcare-related education preferred.
• Must be 21 or older
• Previous experience in healthcare administration, utilization management, medical records, insurance authorization, care coordination, or a related field preferred.
• Familiarity with health insurance terminology, prior authorizations, medical records, and clinical documentation preferred.

Preferred Experience

• Experience in a hospital, health plan, behavioral health, post-acute care, or other healthcare setting.
• Experience working with payer authorization requirements.
• Familiarity with utilization management, medical necessity review, or case management workflows.
• Experience working with electronic medical records and authorization tracking systems.