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Authorization Manager Jobs in Virginia (NOW HIRING)

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Authorization Manager information

How does an authorization manager typically collaborate with other departments to ensure efficient access control processes?

As an Authorization Manager, you will regularly partner with IT, HR, and compliance teams to develop and maintain access control policies. This collaboration ensures that only authorized personnel have access to sensitive systems and data, aligning with organizational security standards. You may also participate in cross-functional meetings to review user access requests and support audits, making strong communication and stakeholder management skills essential for the role.

What are the key skills and qualifications needed to thrive as an authorization manager, and why are they important?

To thrive as an Authorization Manager, you need expertise in healthcare regulations, insurance processes, and prior authorization procedures, usually supported by a degree in healthcare administration or a related field. Familiarity with medical billing software, electronic health records (EHRs), and insurance verification systems is essential. Strong organizational skills, attention to detail, and effective communication abilities set top performers apart in this role. These skills ensure accurate and timely approvals, minimize claim denials, and maintain smooth administrative operations in healthcare organizations.

What is the difference between Authorization Manager vs Credentialing Specialist?

AspectAuthorization ManagerCredentialing Specialist
Required CredentialsBachelor's degree, healthcare administration or related certificationsHealthcare-related certifications, licensing, and credentials
Work EnvironmentHealthcare organizations, insurance companies, hospitalsHospitals, clinics, healthcare networks
Employer & Industry UsageUsed in healthcare management to oversee authorization processesUsed to verify provider credentials and maintain compliance
Common Search & ComparisonOften compared for roles involving patient access and insurance approvalsCompared for roles focused on provider credentialing and compliance

The Authorization Manager primarily oversees the approval process for patient services and insurance claims, ensuring compliance and efficiency. In contrast, the Credentialing Specialist focuses on verifying healthcare providers' credentials and maintaining licensing standards. Both roles are essential in healthcare operations but serve different functions related to authorization and credential verification.

What does an authorization manager do?

An Authorization Manager is responsible for overseeing and managing the process of granting access or permissions to information systems, data, or resources within an organization. They ensure that only authorized individuals have access to sensitive information, often by implementing and maintaining access control policies. Their duties may include reviewing access requests, monitoring compliance with security policies, and coordinating with IT and security teams. Authorization Managers play a key role in protecting an organization's data and ensuring regulatory requirements are met.
What are the most commonly searched types of Authorization jobs in Virginia? The most popular types of Authorization jobs in Virginia are:
What are popular job titles related to Authorization Manager jobs in Virginia? For Authorization Manager jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Authorization Manager jobs in Virginia look for? The top searched job categories for Authorization Manager jobs in Virginia are:
What cities in Virginia are hiring for Authorization Manager jobs? Cities in Virginia with the most Authorization Manager job openings:
Authorization Manager jobs near you
Infographic showing various Authorization Manager job openings in Virginia as of August 2026, with employment types broken down into 100% Full Time. Highlights an 91% In-person, and 9% Remote job distribution.

Clinical Authorization Specialist (Utilization Review)

Hallmark Youthcare Richmond, Inc.

Henrico, VA • On-site

Other

Medical, Retirement

Posted 9 days ago

Job description

As a leading Residential Treatment Center in the Greater Richmond area, Hallmark Youthcare treats adolescents with emotional and behavioral challenges triggered by trauma. Treatment is provided in a warm and friendly environment by a group of well-trained, highly motivated staff that take pride in delivering quality care in a fast-paced environment.
We are seeking a detail-oriented Clinical Authorization Specialist (Utilization Review) to join our healthcare team. The ideal candidate will have experience in prior authorizations, insurance verification, utilization review, and medical necessity determinations. This role is responsible for ensuring that medical services are appropriately authorized, clinically supported, and compliant with payer guidelines before, during, and after patient care.
The Clinical Authorization Specialist serves as a liaison between healthcare providers, insurance companies, and patients to facilitate timely approvals while minimizing denials and delays in care.
In addition, this role maintains communication with referral sources (CSA/FAPT/IACCT) to coordinate placement and reimbursement standards for transfers from emergency placements and document submission to Magellan for Medicaid consideration.
Key Responsibilities

  • Master's degree in health services field.
  • Review and process prior authorization requests for medical procedures, diagnostic testing, medications, therapies, and specialty services.
  • Evaluate clinical documentation to determine medical necessity using payer guidelines, evidence-based criteria, and insurance policies.
  • Perform prospective, concurrent, and retrospective utilization reviews.
  • Communicate with physicians, nurses, case managers, and insurance representatives to obtain required clinical documentation.
  • Submit authorization requests and monitor status through payer portals and electronic health record (EHR/EMR) systems.
  • Track authorization approvals, denials, appeals, and expiration dates to ensure continuity of care.
  • Identify incomplete or missing documentation and coordinate with providers to obtain necessary information.
  • Maintain accurate records of all authorization activities, communications, and determinations.
  • Stay current on payer policies, CMS regulations, and utilization management best practices.
  • Assist with appeals and peer-to-peer review coordination when necessary.
  • Meet productivity, turnaround time, quality, and compliance standards.
Required Qualifications
  • High school diploma or equivalent required; Associate's or Bachelor's degree in a healthcare-related field preferred.
  • Minimum of 2 years of experience in prior authorization, utilization review, medical insurance, case management, including admissions.
  • Strong understanding of commercial insurance, Medicare, Medicaid, and managed care plans.
  • Experience working with electronic medical records (EMR/EHR) and payer authorization portals.
  • Excellent organizational, analytical, and problem-solving skills.
  • Strong verbal and written communication abilities.
  • Ability to prioritize multiple tasks in a fast-paced healthcare environment.

Benefits:
Set schedule Monday- Friday 9 am- 5pm
Full benefit package available
Matching 401K
Time off accrued each payroll
Free employee meals

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