Medical Reviewer/Utilization Reviewer

About the role

• Review medical records and clinical documentation.
• Evaluate prior authorization requests and medical necessity.
• Apply payer guidelines and utilization review criteria.
• Identify missing documentation and support appeals and denials.
• Maintain accurate records and ensure timely case reviews.

• 1–3 years of experience in utilization review, medical review, prior authorization, or clinical documentation.
• Knowledge of U.S. healthcare insurance and medical terminology.
• Experience with InterQual or MCG is an advantage.
• Strong analytical, documentation, and English communication skills.
• Nursing or related healthcare background preferred.