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Authorization Utilization Review Jobs (NOW HIRING)

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 ... Monitor the status of pending authorizations and document updates or changes to treatment plans in ...

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 ... Monitor the status of pending authorizations and document updates or changes to treatment plans in ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... Monitor the status of pending authorizations and document updates or changes to treatment plans in ...

PARKSIDE INC

Utilization Review Specialist

Tulsa, OK · On-site

The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to ... Responsibilities: • Prepares authorization paperwork, processes requests for authorizations, and ...

HHC

UTILIZATION REVIEW SPECIALIST

Indianapolis, IN

Interfaces with Pharmacy and Specialty Clinic staff to initiate authorization of biological and ... Utilization Review nurses' team to ensure timely patient progression through the episode/plan of ...

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How much do authorization utilization review jobs pay per hour?

As of May 31, 2026, the average hourly pay for authorization utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as an Authorization Utilization Review Specialist, and why are they important?

To thrive as an Authorization Utilization Review Specialist, you need a solid understanding of medical terminology, healthcare regulations, and insurance policies, often backed by a clinical background or relevant certifications. Familiarity with utilization management software, electronic health records (EHR), and payer portals is typically required. Strong attention to detail, analytical thinking, and effective communication are vital soft skills for coordinating with providers and payers. These skills ensure accurate authorization decisions, regulatory compliance, and efficient patient care coordination.

What are some common challenges faced by professionals in Authorization Utilization Review roles, and how can they be addressed?

Professionals in Authorization Utilization Review often encounter challenges such as managing high caseloads, navigating complex insurance guidelines, and ensuring timely communication with providers and patients. Staying organized and up-to-date with evolving payer requirements is essential to avoid delays or denials. Building strong collaboration with clinical teams and leveraging electronic health record systems can help streamline workflows and improve efficiency in the review process.

What is Authorization Utilization Review?

Authorization Utilization Review is a process used by healthcare organizations and insurance companies to assess the medical necessity and appropriateness of medical services before they are provided. The main goal is to ensure that patients receive care that is effective, efficient, and covered by their health plan. This review typically involves evaluating patient records, treatment plans, and provider requests to decide if the requested services meet established guidelines. By doing so, it helps control healthcare costs and ensures quality care for patients.

What is the difference between Authorization Utilization Review vs Claims Reviewer?

AspectAuthorization Utilization ReviewClaims Reviewer
CredentialsTypically requires healthcare or insurance-related certifications, such as RN, CPC, or licensed healthcare professionalsOften requires similar credentials, focusing on insurance policies and claims processing
Work EnvironmentHospitals, insurance companies, healthcare facilitiesInsurance companies, third-party administrators, healthcare organizations
Industry UsageUsed to assess medical necessity before approving servicesUsed to evaluate claims for payment accuracy and compliance

Authorization Utilization Review and Claims Reviewer roles both involve insurance and healthcare knowledge, but Authorization Utilization Review focuses on pre-authorization of services, while Claims Review centers on post-service claims assessment. Understanding these differences helps clarify career paths and job expectations in healthcare insurance.

More about Authorization Utilization Review jobs
What cities are hiring for Authorization Utilization Review jobs? Cities with the most Authorization Utilization Review job openings:
What states have the most Authorization Utilization Review jobs? States with the most job openings for Authorization Utilization Review jobs include:
What job categories do people searching Authorization Utilization Review jobs look for? The top searched job categories for Authorization Utilization Review jobs are:
Authorization Utilization Review jobs near you
Infographic showing various Authorization Utilization Review job openings in the United States as of May 2026, with employment types broken down into 1% As Needed, 88% Full Time, 9% Part Time, and 2% Contract. Highlights an 80% Physical, 15% Hybrid, and 5% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review (UR) Specialist

Dove Recovery

Columbus, OH • On-site

Full-time

Posted 11 days ago

Job description

Utilization Review (UR) Specialist
Position Title: Utilization Review Specialist
Department: Clinical / Billing Operations
Reports To: Executive Director & Clinical Director
FLSA Status: Full-Time, Salaried
Location: Dove / Robin Recovery Facilities
Salary Range: 75-85K
Position Summary
The Utilization Review (UR) Specialist is responsible for managing all aspects of authorization, continued stay requests, and utilization review activities for clients receiving treatment services. This position ensures that all clinical documentation submitted to Medicaid and commercial payers meets medical necessity standards, aligns with state and payer requirements, and supports timely approval of authorized days and service units.
The UR Specialist works closely with the Clinical Director, therapists, case management, and billing teams to ensure all documentation is complete, accurate, and submitted within required timelines to maintain uninterrupted client care and maximize revenue reimbursement.
Key Responsibilities
Authorization & Utilization Review
  • Obtain initial authorizations for treatment episodes across all levels of care (PHP, IOP, SUD OP, TBS/PSR, Med Management).
  • Complete continued stay reviews (CSRs) and reauthorization requests by the required deadlines.
  • Submit Medicaid prior authorization (PA) packets including clinical documentation, notes, assessments, and treatment plans.
  • Monitor authorization status in payer portals and maintain communication with Medicaid MCOs (CareSource, Buckeye, Molina, Paramount, UHC, AmeriHealth, etc.).
Documentation & Medical Necessity
  • Review clinical documentation to ensure it meets medical necessity standards required by ODM (Ohio Department of Medicaid) and payer guidelines.
  • Verify that progress notes, assessments, treatment plans, and signatures are complete, accurate, and compliant.
  • Assist clinicians in identifying documentation gaps or areas needing clarification for successful authorization.
  • Ensure timely collection of required documents, including:
    • Comprehensive assessments
    • ASAM Level of Care justifications
    • Treatment plans
    • Progress notes
    • Urine drug screens
    • Psychiatric evaluations
    • Discharge summaries
Coordination & Communication
  • Communicate with Clinical Director and therapists regarding upcoming authorization deadlines, missing documentation, and required updates.
  • Collaborate with billing to ensure authorized units match billed services and resolve discrepancies.
  • Maintain an organized authorization tracker with start dates, end dates, units, and approvals.
  • Respond promptly to payer inquiries and clinical review requests.
Compliance & Quality Assurance
  • Maintain compliance with Medicaid, ODM, CARF/Joint Commission, OhioMHAS, and payer utilization management policies.
  • Ensure documentation standards meet payer audits and state regulatory requirements.
  • Follow up on denials and submit appeals with corrected documentation when appropriate.
Qualifications
Required:
  • Minimum 2 years’ experience in Utilization Review, Medicaid authorization, Behavioral Health Billing, Case Management, or similar role.
  • Strong knowledge of Medicaid MCO authorization portals and processes.
  • Familiarity with medical necessity documentation for behavioral health/SUD.
  • Understanding of ASAM Criteria and justification for levels of care.
  • Ability to read and interpret clinical notes and assessments.
  • Strong communication and coordination skills between clinical and billing departments.
  • High attention to detail and ability to meet strict deadlines.
Preferred:
  • Experience in a Substance Use Disorder or Mental Health treatment center.
  • Knowledge of Alleva EMR or similar EMR platforms.
  • CDCA, QMHS, LSW, or similar credential (not required but beneficial).
Performance Expectations
  • Maintain >95% authorization retention rate for all active clients.
  • Submit all prior authorizations and continued stay reviews before expiration.
  • Zero preventable authorization lapses due to missing documentation.
  • Maintain accurate and up-to-date authorization logs and communication records.
Work Environment
  • Fast-paced behavioral health environment.
  • Remote flexibility depending on needs of department.
  • Requires effective communication with clinical providers and payer representatives.

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