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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 Connecticut?

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

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

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

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

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

Authorization Utilization Review jobs near you
Infographic showing various Authorization Utilization Review job openings in Connecticut as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 2% Temporary, 2% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution.

UTILIZATION REVIEW (UR) SPECIALIST - FULL OR PART TIME

UHS

North Stonington, CT • On-site

Full-time

Medical, Dental, Retirement

This job post has expired today. Applications are no longer accepted.

Universal Health Services rating

6.9

Company rating: 6.9 out of 10

Based on 254 frontline employees who took The Breakroom Quiz

454th of 898 rated healthcare providers

Job description

Responsibilities
Are you caring, compassionate and hardworking? Our facility can provide a place for you to thrive and continue your professional development.
Stonington Institute, a division of one of the nation's largest and most respected hospital companies, Universal Health Services, Inc. (UHS), has an immediate opening for a full or part time UR Specialist.
Stonington Institute is committed to providing quality substance abuse treatment options for adults in Southeastern Connecticut and surrounding areas. We offer medical detox as well as residential addictions treatment for active duty and retired military service members in our North Stonington location. Our clinic in Groton, CT, offers partial hospitalization and intensive outpatient treatment, and is conveniently located across the street from The Inn at Trails Corner, a new 180 bed dormitory-style sober community for adult men and women who attend our outpatient day treatment programs. The Inn offers overnight accommodations, full-meal service, indoor/outdoor recreation options, a workout room, and computer center for all clients. We accept private insurance, state-funded plans and self-pay arrangements.
Job Summary:
The Utilization Review Specialist is responsible for the pre-certification, concurrent, and discharge review process for clients at all levels of care, resulting in the approval of their admission and continued treatment.
Job Duties and Responsibilities
  • Consult with Admissions Department regarding specific LOC issues, insurance requests, and/or criteria questions.
  • Complete initial precertification for all levels of care.
  • Knowledge of UR processes required for all payor sources i.e. precertification, concurrent reviews, discharge review.
  • Conduct concurrent reviews on assigned cases.
  • Ability to identify and advocate for a particular level of care based on the presenting clinical information.
  • Coordinate with colleagues and payors regarding client changes in level of care internally or transitions to other internal programs.
  • Collaborate with clinicians/case managers to obtain pertinent clinical and discharge information.
  • Learn UR Tracking System, Midas; enter daily authorizations and/or other necessary information in a timely manner.
  • Print and monitor UR reports on a daily basis.
  • Document and file all authorization information accurately and completely.
  • Address client insurance changes immediately and communicate results to appropriate departments.
  • Ensure that all applicable information is communicated to the Billing Department on a daily basis.
  • Notify UR Department Head and Billing of any denials and complete telephonic or written appeals when necessary.
  • Liaison between insurance and clinical staff, providing information to clinicians/case managers regarding dispositions that would be approved by insurance.
  • Participate in monthly UR Meeting.

Stonington Institute employees receive great opportunities.
  • Challenging and rewarding work environment
  • Career advancement opportunities
  • Comprehensive Benefits including Medical, Dental, 401K, Tuition Reimbursement and more (for eligible part-time and full-time positions)
  • Competitive Compensation.
Apply today to join our amazing team!
About Universal Health Services
One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Notice
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries.
We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.
Qualifications
Masters Degree preferred; minimum Bachelors Degree in Psychology or related Human Service Field or RN. Knowledge of Utilization Review Processes, insurance plans, mental health and chemical dependency treatment. Knowledge of various treatment levels of care as well as psychiatric diagnosis. Experience with computer skills preferred.

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About Universal Health Services

Sourced by ZipRecruiter

Universal Health Services (UHS) is a major player in the healthcare industry, based in King of Prussia, Pennsylvania, U.S. Founded in 1978, UHS offers hospital and healthcare services. Their diverse services range from acute care hospitals, behavioral health facilities and ambulatory centers nationwide. The company's mission of enhancing the health and well-being of their patients is reflected in their commitment to 'Helping Individuals Live Longer, Healthier and Happier Lives'. Universal Health Services' consistent growth and success in their industry have been recognized on numerous occasions, including being ranked amongst the Fortune 500 list of largest companies.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

King of Prussia, PA, US

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