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Authorization Utilization Review Jobs in Oregon (NOW HIRING)

Soliant Health

Pharmacist in Beaverton, OR

Beaverton, OR · On-site

$61.50 - $74/hr

... authorizations, audits, appeals, and ALJ court hearings * Strong knowledge of clinical policy development, drug utilization review, and medication therapy management * Excellent communication skills ...

Healthcare Support Staffing

Pharmacist

Portland, OR · On-site

$61.75 - $74.25/hr

... authorizations, medication therapy management and drug utilization review Additional Information Are you an experienced Pharmacist looking for a new opportunity with a prestigious healthcare company?

Kairos

Insurance Coordinator

Grants Pass, OR · On-site

Review co-pays, deductibles, coinsurance, visit limits, and authorization requirements * Accurately ... Utilization Management * Obtain and manage prior authorizations for behavioral health services

Kairos

Insurance Coordinator

Grants Pass, OR · On-site

$24.79 - $30.13/hr

Review co-pays, deductibles, coinsurance, visit limits, and authorization requirements * Accurately ... Utilization Management * Obtain and manage prior authorizations for behavioral health services

Kairos

Insurance Coordinator

Grants Pass, OR

Review co-pays, deductibles, coinsurance, visit limits, and authorization requirements * Accurately ... Utilization Management * Obtain and manage prior authorizations for behavioral health services

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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 Oregon?

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

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

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

Authorization Utilization Review jobs near you
Infographic showing various Authorization Utilization Review job openings in Oregon as of September 2026, with employment types broken down into 1% As Needed, 78% Full Time, 18% Part Time, and 3% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution.

*New - Prior Authorization Specialist (Experienced)- Remote

Portland, OR • On-site

NYX Health, LLC
Health Care and Social Assistance • 11 - 50 employees
Learn more about NYX Health, LLCexternal

$21 - $23/hr

Other

Medical, Dental, PTO

Posted yesterday

New

Job description

Prior Authorization Specialist - Remote
Position Summary
We're actively seeking a Prior Authorization Specialist with experience working insurance authorizations in EPIC. You will be responsible for completing insurance verifications, submitting, and tracking prior authorizations, gathering required documentation, communicating with insurance payors and clinicians, and following authorizations through to approval.
Key Responsibilities:
  • EPIC experience required, including general prior authorization process experience.
  • knowledge of Idaho payors is a plus.
  • Ability to independently manage prior authorizations from submission through approval.
  • Communicate with providers and insurance companies regarding authorization status.
  • Maintain HIPAA compliance and support daily revenue cycle operations.
Skills & Qualifications
  • 2+ years of prior authorization experience -Required
  • Proficient EPIC
  • Strong communication, problem-solving, and organizational skills.
  • Detail-oriented, analytical, and able to multitask is helpful.
Education & Experience
  • High School Diploma required; additional education in business or healthcare preferred.
  • Experience in prior authorization, utilization review, insurance verification, and EMR systems.
[preferred]
Work Environment & Physical Requirements
  • Remote position
  • Prolonged computer use; ability to lift up to 15 lbs.
  • Reliable Internet
  • FT M-F - 40 hour work week - PST time zone
  • Hours available between 7am - 6pm
Job Type, Schedule & Compensation
Full-time, Monday-Friday, 8-hour day shift.
Pay: $21-$23 per hour, [With additional pay available for exceptional experience.]
High performers will also be eligible for a performance bonus incentive.
Benefits:
  • Dental insurance
  • Health Insurance
  • Accrued Paid Time Off

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