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Coordinator Aetna Utilization Review Jobs in Florida

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... coordinating with insurance providers to obtain authorization and resolve any issues related to ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... coordinating with insurance providers to obtain authorization and resolve any issues related to ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... coordinating with insurance providers to obtain authorization and resolve any issues related to ...

UHS

UR COORDINATOR - Part Time

Titusville, FL

The Utilization Review Coordinator monitors and coordinates appropriate documentation and utilization of services throughout the course of treatment for patients admitted to the inpatient and ...

UHS

UR COORDINATOR - Part Time

Titusville, FL · On-site

The Utilization Review Coordinator monitors and coordinates appropriate documentation and utilization of services throughout the course of treatment for patients admitted to the inpatient and ...

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Coordinator Aetna Utilization Review information

What are the key skills and qualifications needed to thrive as a Coordinator Aetna Utilization Review, and why are they important?

To thrive as a Coordinator Aetna Utilization Review, you need a background in healthcare or nursing, knowledge of utilization review processes, and familiarity with insurance guidelines, typically supported by a relevant degree or certification. Experience with case management software, electronic health records (EHR), and insurance authorization systems is highly valuable. Strong organizational skills, attention to detail, effective communication, and problem-solving abilities set outstanding candidates apart. These competencies ensure accurate review of medical necessity, compliance with policies, and efficient coordination between providers, patients, and insurers.

How does a Coordinator Aetna Utilization Review typically interact with different healthcare professionals in their daily work?

A Coordinator Aetna Utilization Review regularly collaborates with physicians, nurses, case managers, and insurance representatives to ensure that patient care services are medically necessary and align with established guidelines. This role involves frequent communication to gather clinical documentation, clarify care plans, and resolve discrepancies between providers and payers. Effective coordination and clear communication are essential to streamline the review process and support timely, appropriate patient care. Building professional relationships across departments is key to successfully navigating the complexities of utilization management.

What are Coordinator Aetna Utilization Review positions?

Coordinator Aetna Utilization Review positions are roles within healthcare organizations or insurance companies focused on reviewing and managing the medical services that members receive, ensuring they are necessary and covered by the plan. These coordinators work closely with healthcare providers, patients, and insurance teams to assess medical records, authorize services, and maintain compliance with Aetna's policies and regulations. Their goal is to ensure patients receive appropriate care while controlling costs and preventing unnecessary treatments.

What is the difference between Coordinator Aetna Utilization Review vs Coordinator UnitedHealthcare Utilization Review?

AspectCoordinator Aetna Utilization ReviewCoordinator UnitedHealthcare Utilization Review
CertificationsTypically requires a healthcare-related certification (e.g., RN, LPN, or medical assistant)Similar certifications required, often including RN or medical assistant credentials
Work EnvironmentWorks within Aetna's claims and health plan systems, often in insurance or healthcare settingsOperates within UnitedHealthcare's claims processing and health plan environments
Employer & Industry UsageUsed by Aetna for member care review and authorization processesUsed by UnitedHealthcare for similar utilization management tasks

Both roles involve reviewing healthcare claims and authorizations, requiring similar certifications and working within insurance companies' health plan systems. The main difference lies in the employer and specific internal procedures of Aetna versus UnitedHealthcare, but the core responsibilities and credentials are comparable.

What are the most commonly searched types of Aetna Utilization Review jobs in Florida? The most popular types of Aetna Utilization Review jobs in Florida are:
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Coordinator Aetna Utilization Review jobs near you
Utilization Review Specialist

Utilization Review Specialist

ICBD Holdings LLC

Lauderdale Lakes, FL • On-site

$55K - $70K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Job description

Utilization Review Specialist - Exact Billing Solutions (EBS)
Lauderdale Lakes, FL - On-site - No Remote
Salary: $55K - $70K
Who We Are
Exact Billing Solutions is a unique team of revenue cycle management professionals specializing in the substance use disorder, mental health, and autism care fields of healthcare services. We have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation. With our proprietary billing process, EBS is the oil that brings life to the engines of its partner healthcare companies.
Part of the ICBD portfolio, Exact Billing Solutions combines entrepreneurial speed with the financial discipline of a self-funded, founder-led organization. Our growth reflects a proven ability to solve complex healthcare challenges with operational precision, scalable systems, and client-first innovation.
Recognition & Awards
Exact Billing Solutions contributes heavily to the success of the broader ICBD corporate ecosystem and benefits from the recognition awarded to other portfolio companies, including:
  • Inc. 5000 - 25th Fastest-Growing Private Company in America (2025).
  • Financial Times - #5 on "The Americas' Fastest Growing Companies."
  • EY Entrepreneur Of The Year U.S. Overall.
  • South Florida Business Journal's Top 100 Companies.
  • Florida Trend Magazine's 500 Most Influential Business Leaders.
  • Inc. Best in Business, Health Services.
About the Role
As a Utilization Review Specialist, you will play a pivotal role in ensuring the efficient and effective utilization of healthcare resources.
The UR Records Specialist will assist in reviewing and processing records to submit for authorization to the payors. This position collaborates closely with clinical teams, insurance providers, and other healthcare professionals to support efficient and effective patient care.
Key Responsibilities
  • Review and analyze clinical records, including received documentation from payors, to ensure compliance with ABA therapy best practices and insurance requirements.
  • Accurately input and maintain clinical records, authorization requests, and related documents into the electronic health records (EHR) or other relevant systems.
  • Assist in tracking and organizing all documentation for utilization reviews, ensuring that all records are complete, accurate, and accessible for audits and reviews.
  • Monitor the status of pending authorizations and document updates or changes to treatment plans in a timely manner.
  • Assist in processing and reviewing requests for treatment authorization, working with clinicians to verify that all necessary documentation is available for review.
  • Assess the appropriateness and necessity of healthcare services, ensuring they align with established guidelines and policies.
  • Work closely with interdisciplinary teams, Board Certified Behavior Analysts, Registered Behavior Technicians, and other healthcare professionals to gather insights and ensure comprehensive reviews.
  • Assist in preparing records and documentation for external audits or insurance company reviews, ensuring that all necessary information is submitted and compliant with guidelines.
  • Identify any discrepancies, missing documentation, or areas where clinical records may require updates to meet the standards.
  • Assist in coordinating with insurance providers to obtain authorization and resolve any issues related to service utilization or claims denials.
  • Provide requested documentation and supporting materials for authorization and reauthorization requests, ensuring timely submission to insurance companies.
  • Maintain records of communications with insurance companies, clinical teams, and other relevant stakeholders.
  • Analyze trends in authorization requests, approvals, and denials and provide reports or insights to management to identify areas for process improvement.
  • Track utilization patterns, service delivery, and compliance with payer requirements to support continuous improvement in the utilization review process.
  • Communicate effectively with team members to ensure the smooth processing of treatment authorizations and timely updates on status or concerns.
  • Provide clear communication regarding the status of clinical record reviews, authorization requests, and insurance queries.
  • Participate in quality-improvement initiatives to enhance the overall efficiency and effectiveness of healthcare delivery.
Requirements
  • Associate's or Bachelor's degree in Healthcare Administration, Medical Records, Behavioral Health, or a related field.
  • Certification in Health Information Management (e.g., RHIA, RHIT) is a plus but not required.
  • Minimum of 1 year of experience working with clinical records, medical documentation, or utilization review, preferably in ABA therapy, behavioral health, or healthcare settings.
  • Proven experience in utilization reviews or a related field with a strong understanding of healthcare service delivery and documentation processes is highly desirable.
  • Must maintain clean background/drug screenings and driving record.
Expertise Needed
  • Familiarity with industry standards, guidelines, and best practices related to utilization review.
  • Ability to analyze complex clinical documentation, treatment plans, and medical records.
  • Strong critical thinking skills to assess the appropriateness and necessity of healthcare services.
  • Strong analytical and critical thinking skills.
  • Excellent communication and interpersonal skills.
Benefits
  • 21 paid days off (15 PTO days increasing with tenure, plus 6 paid holidays)
  • Flexible Spending Account (FSA) and Health Savings Account (HSA) options
  • Medical, dental, vision, long-term disability, life insurance, AD&D insurance, and GAP Plan (TransAmerica)
  • Generous 401(k) with up to 6% employer match
  • 100% employer-paid maternity/paternity leave for up to 5 weeks
  • Tuition reimbursement up to $2,500 per semester
  • EAP (unlimited counseling 24/7), BeyondMed (discounts on wellness and elective healthcare services), PerkSpot (discounts on top brands), Pet Insurance (Nationwide), and On the GoGa wellbeing hub

Closing Statement
Exact Billing Solutions is an Equal Opportunity Employer and is committed to building an inclusive workplace free from discrimination. We make employment decisions based on qualifications, merit, and business needs, and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic under applicable law.
Exact Billing Solutions participates in the U.S. Department of Homeland Security E-Verify program.

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