Utilization Review Coordinator

Job Overview

We are seeking a highly organized and detail-oriented Utilization Review Coordinator to support multiple healthcare facilities by managing insurance authorizations and utilization review processes. This role focuses on ensuring that authorization requests and reviews are submitted accurately, tracked efficiently, and completed within required timeframes, while maintaining compliance with payer and regulatory guidelines.

The ideal candidate is comfortable working in a fast-paced, deadline-driven environment, communicates professionally with external stakeholders, and has strong administrative and tracking skills.

Key Responsibilities

Insurance Authorizations & Utilization Review

• Submit initial authorization requests and concurrent reviews to medical insurance providers
• Track authorization due dates, follow-ups, and approval statuses across multiple cases
• Ensure all required clinical and administrative documentation is complete and submitted on time

• Monitor authorization expirations and coordinate timely renewals

Communication & Coordination

• Communicate with insurance providers via phone, fax, and online portals

• Liaise with internal healthcare and administrative teams to gather required documentation
• Provide clear updates on authorization status and outstanding requirements

Compliance & Documentation

• Follow payer guidelines, utilization review requirements, and regulatory standards

• Maintain accurate, well-organised records and tracking systems

• Ensure consistency and attention to detail across all submissions

Required Skills & Competencies

• Strong organisational and time-management skills

• Ability to manage multiple deadlines and priorities simultaneously

• Clear, professional written and verbal communication

• High attention to detail and accuracy

• Comfortable working with systems, spreadsheets, and online portals

Preferred Experience

• Previous experience in:

  • Insurance authorizations

  • Utilization review

  • Healthcare administration or medical billing support

• Experience working with international (particularly US-based) healthcare systems is an advantage

• Clinical qualifications are not required

Work Environment

• Fully remote role based in South Africa

• Works standard business hours aligned to client requirements

• Administrative and compliance-focused healthcare support role