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Authorization Utilization Review Jobs in Indiana

Astyra Corporation

Clinical Reviewer

Indianapolis, IN · Remote

$36 - $40/hr

Associate's degree (Bachelor's preferred) or diploma from an accredited nursing program * 2+ years of Utilization Review/Management (UR/UM) and/or Prior Authorization experience * 2+ years of medical ...

Damar Services, Inc.

BCBA - Part-time

Indianapolis, IN

$70K - $86K/yr

Reviews client assessments, treatment plans, behavior plans, and other protocols at a minimum of ... Maintains high authorization utilization of assigned caseload * May provide direct therapy to ...

Damar Services, Inc.

BCBA - Part-time

Indianapolis, IN · On-site

$70K - $86K/yr

Reviews client assessments, treatment plans, behavior plans, and other protocols at a minimum of ... Maintains high authorization utilization of assigned caseload * May provide direct therapy to ...

Damar Services, Inc.

BCBA

Indianapolis, IN

$70K - $86K/yr

Reviews client assessments, treatment plans, behavior plans, and other protocols at a minimum of ... Maintains high authorization utilization of assigned caseload * May provide direct therapy to ...

Damar Services, Inc.

BCBA

Indianapolis, IN

$70K - $86K/yr

Reviews client assessments, treatment plans, behavior plans, and other protocols at a minimum of ... Maintains high authorization utilization of assigned caseload * May provide direct therapy to ...

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Authorization Utilization Review information

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 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 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 popular job titles related to Authorization Utilization Review jobs in Indiana? For Authorization Utilization Review jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Authorization Utilization Review jobs in Indiana look for? The top searched job categories for Authorization Utilization Review jobs in Indiana are:
What cities in Indiana are hiring for Authorization Utilization Review jobs? Cities in Indiana with the most Authorization Utilization Review job openings:
Authorization Utilization Review jobs near you
Clinical Reviewer

Clinical Reviewer

Astyra Corporation

Indianapolis, IN • Remote

$36 - $40/hr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 15 days ago

Job description

Job Summary

The purpose of this position is to utilize clinical expertise to review medical records against established criteria in accordance with contract requirements.

Location: Remote (U.S.-based)
Licensure Requirement: Must hold an active clinical license in the State of Indiana or a Compact State license

Work Schedule:

  • 40 hours per week - Friday, Saturday, Sunday, and two weekdays
  • Weekend and/or holiday availability required 

Training Requirement:

  • Must be fully available to attend 100% of training
  • Schedule: Monday–Friday, 9:00 AM – 6:00 PM EST
  • Duration: Minimum of 3 weeks
Key Responsibilities
  • Ensure accuracy and timeliness of all review cases in accordance with contract requirements
  • Manage daily workload and queues; adjust workflow as needed to meet departmental demands
  • Collaborate with Supervisor on quality monitoring and improvement activities
  • Maintain current knowledge of clinical practices and review processes
  • Serve as a liaison for providers regarding customer service issues and resolution
  • Perform various review types as assigned based on workload
  • Build and maintain professional relationships with internal and external stakeholders
  • Attend required trainings and team meetings
  • Cross-train to support business and client needs
  • Comply with all corporate policies, including HIPAA Privacy and Security regulations

Note: Responsibilities may evolve based on business needs.
 

Required Qualifications
  • Active, unrestricted LPN/LVN or RN license in Indiana or Compact State
  • Associate’s degree (Bachelor’s preferred) or diploma from an accredited nursing program
  • 2+ years of Utilization Review/Management (UR/UM) and/or Prior Authorization experience
  • 2+ years of medical necessity review experience
  • 1+ year of InterQual and/or Milliman Care Guidelines (MCG) experience
  • Strong knowledge of medical records, terminology, and disease processes
  • Excellent clinical assessment and critical thinking skills
  • Strong written and verbal communication skills
  • Ability to navigate multiple systems efficiently
  • Strong organizational skills and flexibility
Preferred Qualifications
  • 3+ years of clinical experience (acute care, behavioral health, and/or med-surgical)
  • Knowledge of NCQA and URAC standards
  • Experience working in a team-based environment
  • Proficiency in Microsoft Office
  • Strong time management and prioritization skills
  • Demonstrated ability to maintain confidentiality and ensure HIPAA compliance
Weekend and holiday flexibility is required
Proper email communication will only be done to and from @astyra.com email addresses. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. Please ensure you are communicating within these guidelines and proper channels for the quickest possible interview consideration!
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