New York Licensed Utilization Coordinator

A company is looking for a Utilization Management Coordinator - Compliance.

Key Responsibilities

Review and analyze member cases for medical necessity and appropriateness of treatment authorizations

Conduct internal audits and readiness assessments for accreditation reviews, ensuring compliance with standards

Serve as a liaison between internal and external partners, coordinating documentation and communication for authorization requests

Required Qualifications

Bachelor's degree in nursing

1+ year of fertility nursing experience required

Minimum 2 years of experience in UM compliance or accreditation preparation preferred

Current licensed professional registered nurse

Familiarity with URAC / NCQA standards and state-specific UM regulations