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Authorization Utilization Review Jobs in Colorado

UHS

DIR - UTILIZATION REVIEW / MGMT

Colorado Springs, CO · On-site

$85K - $120K/yr

Reviews all cases for days that were not authorized to determine appeal options. Conducts routine ... Provides Utilization Management consultations to UM department and other hospital departments as ...

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Authorization Utilization Review information

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.

What are popular job titles related to Authorization Utilization Review jobs in Colorado?

For Authorization Utilization Review jobs in Colorado, the most frequently searched job titles are:

What job categories do people searching Authorization Utilization Review jobs in Colorado look for?

The top searched job categories for Authorization Utilization Review jobs in Colorado are:

What cities in Colorado are hiring for Authorization Utilization Review jobs?

Cities in Colorado with the most Authorization Utilization Review job openings:

Authorization Utilization Review jobs near you
Infographic showing various Authorization Utilization Review job openings in Colorado as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 15% Part Time, 4% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution.

Utilization Review Coordinator

Alsos Behavioral Health

Aurora, CO • On-site

$64K/yr

Full-time

Posted 6 days ago

Job description

EOE Statement
We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.
Description
Position Summary
Salary $64,000
The UR and RCM Support Coordinator is responsible for securing and maintaining payer authorizations across all levels of care for residential substance use disorder (SUD) treatment, including ASAM Levels 3.5 and 3.7, while also providing cross-functional support to the Revenue Cycle Management department. This role serves as a key link between the clinical team, payers, and the RCM department, ensuring that medical necessity is clearly documented, communicated, and defended throughout each patient's episode of care.
Reporting to the Director of Utilization Review with a dotted-line relationship to the Director of Revenue Cycle Management, the UR and RCM Support Coordinator works in close partnership with billing, denials, appeals, and clinical leadership to drive authorization approval rates, prevent denials at the front end, and protect revenue across the multi-state network of facilities. This is a high-visibility role with direct impact on length of stay, denial rates, and net collections.
Essential Duties and Responsibilities
Authorization Management
  • Complete pre-certification, initial, concurrent, and discharge reviews with commercial, Medicaid, and Medicaid managed care payers for residential SUD levels of care (ASAM 3.1, 3.5, 3.7, and detox where applicable).
  • Submit clinical information to payers within required timeframes, using ASAM criteria and payer-specific medical necessity guidelines to justify admission, continued stay, and level of care.
  • Track all authorization requests, approvals, days approved, next review dates, and denials in the UR tracking system; ensure no patient day is at risk due to a missed or expired authorization.
  • Escalate authorization issues, denials, or peer-to-peer requests to the Director of Utilization Review and Director of RCM in real time, along with clinical leadership as appropriate.

Peer-to-Peer and Denial Prevention
  • Coordinate, prepare, and schedule peer-to-peer reviews between facility physicians and payer medical directors; provide the rendering clinician with a written summary of medical necessity points prior to each call.
  • Document peer-to-peer outcomes, including outcome reason, reviewer name, and any payer-specific feedback for use in future submissions.
  • Partner with the Director of Utilization Review and Director of RCM, along with the appeals team, to identify trends in concurrent denials and translate findings into documentation and clinical workflow improvements.
  • Support the appeals process by providing UR notes, clinical timelines, and the authorization history needed for first- and second-level appeals.

Clinical Documentation Partnership
  • Review clinical documentation daily for alignment between the billed level of care and the documented level of care; flag and address mismatches before they generate denials (a known driver of pre-payment review and payer recoupment risk).
  • Provide real-time coaching and written feedback to clinicians, therapists, and medical providers on documentation elements required to meet ASAM 3.5 and 3.7 medical necessity (e.g., dimensional risk ratings, withdrawal management needs, biomedical and behavioral complications, treatment response, and continued-stay justification).
  • Partner with clinical leadership to maintain documentation templates and standards that satisfy commercial payer, state Medicaid, and accreditation requirements across Arkansas, Colorado, Indiana, Kentucky, and Ohio.

Revenue Cycle Coordination
  • Work alongside the RCM team to support resolution of authorization-driven holds, write-off recommendations, and pre-payment review responses, providing UR expertise and clinical context as needed.
  • Provide the billing team with accurate authorization numbers, approved date ranges, level-of-care designations, and modifier guidance to ensure clean claim submission.
  • Participate in standing meetings with the Director of Utilization Review, Director of RCM, billing manager, and denials/appeals leads to review denial trends, hold billing volume, AR aging by payer, and authorization-related risk.
  • Contribute to executive-facing reporting on UR performance, including authorization approval rates, average days authorized, peer-to-peer outcomes, and denial root cause.
  • Support the RCM team as needed with cash posting, billing, and denial reconciliation activities, particularly during peak volume, staff coverage gaps, or special projects.
  • Participate in the implementation, testing, and rollout of new software platforms, payer portals, and operational processes; provide UR-side workflow input, validate functionality, and assist with end-user training and adoption across facilities.

Payer Relationships and Compliance
  • Maintain working knowledge of payer-specific medical necessity criteria, review timelines, submission portals, and documentation requirements for Ambetter, UnitedHealthcare, Optum, Aetna, Cigna, Anthem/Elevance, Colorado Access, state Medicaid programs, and Medicaid managed care plans operating in network states.
  • Track payer policy changes, level-of-care criteria updates, and contract requirements; communicate impact to RCM and clinical leadership.
  • Support payer pre-payment reviews, audits, and medical record requests by assembling complete UR packets within required timeframes.
  • Maintain strict compliance with HIPAA, 42 CFR Part 2, state confidentiality laws, and organizational policy in all payer communications.

Position Requirements
Qualifications
Required
  • Active, unrestricted clinical license in good standing (RN, LPN, LCSW, LPC, LMFT, LCDC/LADC, or equivalent behavioral health license) OR equivalent UR experience acceptable to the organization.
  • Minimum of 2 years of utilization review, case management, or care coordination experience in behavioral health, substance use disorder, or mental health treatment.
  • Demonstrated working knowledge of ASAM Criteria, with the ability to apply dimensional assessments to medical necessity submissions.
  • Direct experience completing concurrent reviews with commercial and/or Medicaid payers for residential SUD or behavioral health levels of care.
  • Strong written and verbal communication skills, with the ability to summarize complex clinical information into concise medical necessity language.
  • Proficient in electronic health records, payer portals, and Microsoft Office (Excel, Word, Outlook, Teams).

Preferred
  • Experience supporting multi-state operations or multi-facility provider networks.
  • Prior experience working within or alongside a Revenue Cycle Management department, including familiarity with denials, appeals, and AR workflows.
  • Working knowledge of state Medicaid behavioral health billing requirements (e.g., Ohio rendering practitioner/NPI rules, Colorado HCPF supervising clinician and modifier requirements, Kentucky and Indiana ASAM billing structures, Arkansas OBHS billing).
  • Experience handling pre-payment reviews and supporting payer audit responses.

Knowledge, Skills, and Abilities
  • Ability to think both clinically and financially - to recognize when documentation will not support the billed level of care and intervene before claims are submitted.
  • Strong organizational skills and the ability to manage a high volume of concurrent reviews across multiple facilities, payers, and time zones without missing deadlines.
  • Comfort working independently in a remote environment while maintaining tight collaboration with clinical, billing, and leadership teams.
  • Sound judgment in escalating risk: when to request a peer-to-peer, when to engage the Director of Utilization Review or Director of RCM, and when to involve clinical leadership.
  • Discretion and professionalism in all payer-facing communications; the UR Coordinator represents the organization to payer medical directors and case managers.

Key Performance Indicators
Performance will be evaluated against, but not limited to, the following measures:
  • Initial authorization approval rate by payer and level of care.
  • Concurrent review approval rate and average days approved per review.
  • Peer-to-peer overturn rate.
  • Concurrent denial rate and root-cause distribution (medical necessity vs. documentation vs. timeliness).
  • Timeliness of review submission (meeting or exceeding payer deadlines).
  • Authorization-related hold billing volume and aging.

Working Conditions and Physical Requirements
  • Primarily remote, office-based work; extended periods of computer and phone use.
  • Standard business hours with occasional flexibility required to meet payer deadlines or accommodate peer-to-peer scheduling across time zones.
  • Occasional travel to facilities or payer meetings may be required.

Full-Time/Part-Time
Full-Time
Shift
-not applicable-
Position
Utilization Review Coordinator
Division
Sheridan Grove Recovery
Number of Openings
1
Exempt/Non-Exempt
Non-Exempt
Hiring Manager(s)
Tracy Polk
Location
DEN1
About the Organization
Healing with Dignity, Recovery with Purpose.
Oak Grove Recovery proudly serves the Columbus, Ohio, community by providing compassionate, judgment-free addiction treatment. Our dedicated team is available 24/7 to support each individual on their healing journey, offering care rooted in dignity, purpose, and unwavering respect.
This position is currently accepting applications.

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