Utilization Review Specialist

Job overview

The Utilization Review Specialist is an onsite role in Villa Rica, GA. Compensation is not specified. The role supports Verida’s review and administration of member transportation requests, including requests related to Medicaid services. The specialist evaluates requests outside mileage guidelines and non-covered services or locations, processes approved standing-order transportation requests, investigates complaints, and prepares reports. This work supports consistent application of transportation program guidelines and communication with clients and members.

What you'll do

• Review and make approval or denial determinations for transportation requests outside geographical mileage guidelines and requests involving non-covered Medicaid services or locations
• review facilities seeking participation in the standing-order transportation program
• process approved standing-order requests
• investigate provider complaints and issue member warning letters when warranted
• and complete daily denial, member no-show, and monthly denial summary reports.

What we're looking for

Skills & competencies

utilization review specialist

full-time

villa rica ga

verida

medicaid

medicare

transportation requests

request review

approval and denial decisions

standing orders

member services

complaint investigation

reporting

Work arrangement

• Weekend coverage required

Why this role

Requires a high school diploma or equivalent and two years of customer service experience or healthcare industry employment; knowledge of Medicare and Medicaid is listed.

About the employer

Verida Inc is hiring for this role. Industry: Administration of Human Resource Programs (except Education, Public Health, and Veterans' Affairs Programs). Sector: 92.