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Authorization Utilization Review Jobs in Ohio (NOW HIRING)

Sevita

Utilization Review Specialist

Akron, OH · On-site

$40K/yr

SUMMARY The Utilization Review Specialist is responsible for proactive planning measures, accurate ... Provides professional oversight of service delivery authorizations and assurances, effective ...

Nationwide Children's Hospital

Performs pre-certifications, pre-authorizations, re-authorization, concurrent utilization reviews, retrospective reviews, and denial management. Interacts with staff and departments of the hospital ...

syfs

UR Manager

Columbus, OH · On-site

For billing and hospitalization utilization review purposes, the reviewer will identify and certify the acute hospitallength of stay authorized for each case. Initiate and maintain medical records ...

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Authorization Utilization Review information

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 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 Ohio? For Authorization Utilization Review jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching Authorization Utilization Review jobs in Ohio look for? The top searched job categories for Authorization Utilization Review jobs in Ohio are:
What cities in Ohio are hiring for Authorization Utilization Review jobs? Cities in Ohio with the most Authorization Utilization Review job openings:
Authorization Utilization Review jobs near you
Infographic showing various Authorization Utilization Review job openings in Ohio as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Utilization Review Specialist

Sevita

Akron, OH • On-site

$40K/yr

Full-time

Re-posted 15 days ago

Sevita Health rating

5.7

Company rating: 5.7 out of 10

Based on 284 frontline employees who took The Breakroom Quiz

785th of 887 rated healthcare providers

Job description

REM Community Services, a part of the Sevita family, provides community-based services for individuals with intellectual and developmental disabilities. Here we believe every person has the right to live well, and everyone deserves to have a fulfilling career. You’ll join a mission-driven team and create relationships that motivate us all every day. Join us today, and experience a career well lived. 

Salary: $40,170.00

Location: Akron(Portage Lakes area)

Schedule: Mon/Tue/Wed/Thur/Fri 8:30 AM - 5:00 PM

Bachelor’s degree required

OUR MISSION AND PERFORMANCE EXPECTATIONS 

The MENTOR Network is a mission-based organization dedicated to providing high quality services to those we serve.  Therefore, to deliver on our mission, The Network expects every employee to perform his or her job first and foremost in accordance with the Company’s mission.

SUMMARY

The Utilization Review Specialist is responsible for proactive planning measures, accurate documentation of services delivered for audit assurances, and positive outcomes regarding effective service utilization to customers.  Provides professional oversight of service delivery authorizations and assurances, effective tracking and timely recommendations in regards to service delivery utilization parameters, and quality assurance of service delivery records on an ongoing basis.
 

ESSENTIAL JOB FUNCTIONS

To perform this job successfully, an individual must be able to satisfactorily perform each essential function listed below:

  • Develops plans to accurately measure documentation of services delivered to assure compliance with auditors
    • Oversees service delivery authorizations and provides quality assurances of service delivery records
Reviews all service delivery documentation Analyzes the delivery of services and coordination of required service documentation including corresponding billing tickets Tracks current and approved Individual Service Plan and corresponds with areas of support services and service delivery documentation records Verifies billing ticket/pre invoices submitted for processing with all required information
    • Recommends service delivery utilization parameters
  • Maintains knowledge of updated funding Rules and Contracts
    • Notifies internal stakeholders for any updated information on service delivery, authorizations, and utilization of services
  • Maintains organized and complete records and assures quality focused service delivery method strategies
    • Monitors the regional office and storage filing systems
    • Organizes records including availability for compliance audit file review
  • Provides technical assistance to clinical staff in the service areas
    • Facilitates timely and appropriate service authorization
    • Monitors strategies
    • Provides report analysis of actual service deliveries in comparison to authorized service approvals
  • May direct and supervise clerical and administrative staff
    • Provides feedback on performance evaluations
    • Conducts scheduling, orientation, and training
    • Resolves issues and serves as resource
  • Performs other related duties and activities as required 

SUPERVISORY RESPONSIBILITIES

May direct and supervise clerical and administrative staff, including performance evaluations, scheduling, orientation, and training.  Provides feedback on employee performance and resolves issues within position responsibilities.

Minimum Knowledge and Skills required by the Job

The requirements listed below are representative of the knowledge, skill, and/or abilities required to perform the job: 

 

Education and Experience: 

  • Bachelor’s degree required
  • 1 year minimum work experience in human services required

Certificates, Licenses, and Registrations:

  • None

Other Skills and Abilities:

  • For Ohio – Basic Excel skills and ability to learn the Ohio state billing software

Other Requirements:

  • Travel as needed

Physical Requirements:

  • Sedentary work.  Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body.  Sedentary work involves sitting most of the time.  Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

 

AMERICANS WITH DISABILITIES STATEMENT

External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job functions either unaided or with assistance of a reasonable accommodations to be determined on a case by case basis.


Sevita is a leading provider of home and community-based specialized health care. We believe that everyone deserves to live a full, more independent life. We provide people with quality services and individualized supports that lead to growth and independence, regardless of the physical, intellectual, or behavioral challenges they face.
We’ve made this our mission for more than 50 years. And today, our 40,000 team members continue to innovate and enhance care for the 50,000 individuals we serve all over the U.S.
 

As an equal opportunity employer, we do not discriminate on the basis of race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, veteran status, citizenship, or any other characteristic protected by law. 

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About Sevita

Sourced by ZipRecruiter

Sevita is a leading provider of home and community-based specialized health care. We believe that everyone deserves to live a full, more independent life. We provide people with quality services and individualized support that leads to growth and independence, regardless of the physical, intellectual, or behavioral challenges they face. We've made this our mission for more than 50 years. And today, our 40,000 team members continue to innovate and enhance care for the 50,000 individuals we serve. We're an Equal Opportunity Employer, including disability/vets. Sevita is a leading provider of home and community-based specialized health care, similar companies include Brookedale Senior Living, A New Hope, and North Star.

Industry

Nursing and residential care facilities

Company size

10,000+ Employees

Headquarters location

Boston, MA, US

Year founded

1980

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