Utilization Review Clinical Liaison

ABOUT US:

Ethos Risk Services is a leading insurance claims investigation and medical management company committed to providing better data that translates into better decision-making for our clients. We are at the forefront of innovation in our space, and our success is driven by a dynamic team passionate about delivering exceptional services to our customers.

JOB SUMMARY:

Our Ethos Medical Management Team is seeking a full-time Utilization Review Clinical Liaison (REMOTE – PST HOURS) to play a vital role in ensuring seamless communication between intake and 1st level nurse review processes. This position is responsible for coordinating utilization review cases, facilitating timely and accurate information exchange, and helping streamline workflows to ensure efficient and compliant case handling.

KEY RESPONSIBILITIES:

• Serve as the primary point of contact for 1st level utilization review (UR) cases.
• Coordinate 2nd level escalations based on 1st level protocols.
• Assist with triaging incoming cases, assessing urgency, and routing appropriately.
• Collaborate closely with clinical staff to ensure timely communication and completion of case documentation (JDD).
• Maintain confidentiality and compliance with HIPAA standards.
• Perform other related duties as assigned.

QUALIFICATIONS:

Education: High school diploma or equivalent required.

Experience:

• Minimum of 2 years of experience in a healthcare environment such as a clinic, hospital, or medical office (required).
• Familiarity with medical terminology and patient scheduling or triage coordination.
• Strong organizational and communication skills.
• Experience in patient scheduling or triage coordination.

WORKING CONDITIONS:

This position is 100% remote, requiring standard business hours of 8:00 AM to 5:00 PM Pacific Standard Time (PST). If you're located in another time zone, you must be able to adjust your schedule to align with PST hours, including occasional flexibility to start earlier or work later as needed. Candidates should have a dedicated workspace with reliable high-speed internet. The role involves extended periods of sitting, frequent computer use, and regular communication via phone, email, and other digital platforms.

Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristic.