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Authorization Utilization Review Jobs (NOW HIRING)

Discovery Institute

Utilization Review

Marlboro, NJ · On-site

Monitor authorization expiration dates and request extensions before expiration. * Communicate ... Participate in utilization review meetings and case conferences. * Generate reports on ...

US Tech Solutions

Utilization Review Nurse

Chicago, IL · On-site

Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and ... Must have prior authorization utilization experience * Experience with Medcompass Skills: * MUST ...

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

Communicate authorization decisions with physicians, provider offices, hospitals, and healthcare ... Utilization Management (UM) * Medical Necessity Review * Prior Authorization * Precertification

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How much do authorization utilization review jobs pay per hour?

As of Sep 15, 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 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 are the key skills and qualifications needed to thrive as an authorization utilization review specialist?

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 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.

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Authorization Utilization Review jobs near you
Infographic showing various Authorization Utilization Review job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 81% Full Time, 16% Part Time, and 2% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Specialist

Benton, AR • On-site

The Wellstone Group
See more jobs at The Wellstone Groupexternal

Other

Posted 12 days ago

Job description

Utilization Review Specialist – North Little Rock, AR (72113)

Are you an experienced healthcare professional looking for an opportunity to make a difference in patient care management? We’re seeking a Utilization Review Specialist to join our team in North Little Rock, AR, helping ensure effective resource use while maintaining high-quality care within a managed care system.

About the Role:

This position plays a key role in reviewing patient care plans, collaborating with interdisciplinary teams, and ensuring compliance with insurance and regulatory requirements. The right candidate will be detail-oriented, organized, and able to manage multiple priorities in a fast-paced, office-based environment.

Key Responsibilities:

  • Review and Update Records: Ensure patient records and care plans are accurate before submission to insurance providers.

  • Admissions & Discharges: Verify documentation for new admissions and discharges is complete and timely.

  • Daily Workflow: Prepare due lists, send update notifications, and follow up on pending authorizations.

  • Utilization Review: Conduct pre-authorizations and concurrent reviews to confirm the necessity and appropriateness of care.

  • Collaboration: Partner with providers, case managers, and other healthcare professionals to support effective care planning.

  • Compliance: Maintain adherence to state, federal, and organizational guidelines.

  • Appeals Management: Review and respond to appeals related to utilization decisions.

  • Quality Initiatives: Participate in projects aimed at improving patient outcomes and operational efficiency.

Qualifications:

  • Long-term care experience required

  • Active COTA or PTA license

  • Minimum 1 year of experience in MDS, COTA, PTA, or related field, preferably in a managed care setting

  • Strong understanding of managed care principles and clinical guidelines

  • Ability to handle a high caseload with excellent organizational skills

  • Experience or willingness to learn systems such as PCC, Care Auth, Net Health, Availity, and Home & Community services

  • Proficient in Microsoft Excel, Outlook, PDFs, and web-based platforms

Preferred Skills:

  • Experience with Electronic Health Record (EHR) systems

  • Strong multitasking abilities in a high-volume office setting

  • Effective communication and problem-solving skills

Work Environment:

  • On-site position at our North Little Rock, AR office

  • Fast-paced, team-oriented environment requiring strong time management and attention to detail

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