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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 Utah?

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

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

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

Authorization Utilization Review jobs near you
Infographic showing various Authorization Utilization Review job openings in Utah as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 17% Part Time, 2% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution.

Behavioral Health Utilization/Authorization Specialist

Threshold Billing Solutions

Sandy, UT

Full-time

Medical, Dental, Vision, Life, PTO

Re-posted 24 days ago

Job description

Description

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Posting
We are seeking a Behavioral Health Utilization Review / Authorization Specialist to support clinical authorization and utilization management for substance use disorder and mental health treatment programs. This role works closely with insurance companies and treatment providers to obtain authorizations for ASAM levels of care, including detoxification, residential, PHP, IOP and GOP treatment services.
 
Position Summary
The Utilization/Authorization Specialist plays a key role in advocating for clients by obtaining treatment authorizations and facilitating communication between providers and insurance payers. This position is responsible for reviewing behavioral health clinical documentation, submitting authorization requests, and ensuring accurate, timely tracking of coverage. The ideal candidate will be detail-oriented, organized, capable of communicating clearly with both internal teams and external insurance representatives, and may have direct clinical experience working as a Peer Support Specialist, Case Manager, SUDC, LCSW/CSW, CMHC in the substance abuse or mental health treatment field.
 
Experience in Utilization Review Not Required
While prior utilization review experience is always valued, many of our most successful team members have come from a variety of backgrounds within the behavioral health treatment field. Candidates who have worked in residential treatment centers, outpatient programs, or other clinical/administrative behavioral health settings often transition very well into this role. Their firsthand understanding of the treatment process, client needs, and clinical workflows provides an excellent foundation for learning utilization review.
 
We provide comprehensive training and ongoing support, so if you bring a strong work ethic, attention to detail, and a passion for supporting access to care, you can thrive with us even without previous UR experience.
 
Key Responsibilities
 
  • Maintain proactive and effective communication with insurance payers and managed care organizations.
  • Review and interpret clinical documentation, case notes, and assessments to determine and advocate for the appropriate level of care.
  • Prepare and submit initial and concurrent authorization requests, as well as appeals when necessary.
  • Enter and update authorization details in internal data systems accurately and promptly.
  • Track ongoing authorization needs across all levels of care (RTC, PHP, IOP, OP).
  • Communicate with facility staff and internal departments regarding client coverage and clinical needs.
  • Serve as a client advocate, ensuring access to appropriate care through effective payer communication.
  • Ensure timely documentation of all authorizations, decisions, and payer communications.
  • Perform other related duties as assigned.
 
Qualifications
 
  • May have direct clinical/behavioral health experience working as a Peer Support Specialist, Case Manager, SUDC, LCSW/CSW, CMHC in the substance abuse or mental health treatment field is preferred (but not required).
  • Experience in behavioral health or utilization review preferred (but not required).
  • Knowledge of CPT/ICD-10 coding, ASAM/LOCUS criteria, and EMR systems is a plus but not a requirement.
  • Strong verbal and written communication skills.
  • Excellent organization and attention to detail; able to manage multiple tasks and priorities.
  • Critical thinking and analytical skills with the ability to interpret and present clinical information.
  • Ability to work independently and as part of a collaborative team.
  • Proficiency in Microsoft Office and Google Workspace.
  • Comfortable working in a fast-paced environment with deadlines and competing priorities.
 
Education & Experience
 
  • High school diploma or equivalent required. Associate’s degree or higher preferred.
  • At least 1 year of experience in behavioral health or utilization review preferred (not required).
  • Prior experience in the substance use and/or mental health treatment field is highly valued.
  • Licensed or credentialed as a Peer Support Specialist, Case Manager, SUDC, LCSW/CSW, CMHC in the substance abuse or mental health treatment field is preferred (but not required).
 
 Benefits
 
  • Health, dental, and vision insurance
  • Paid time off (PTO)
  • Sick Time
  • Life insurance
  • Short- and long-term disability coverage
  • Lunch catered two times per week
  • Supportive, team-oriented work environment
  
Work Environment
 

  • This is a full-time, on-site position located at our Sandy, Utah office.
 
To Apply: Please submit your resume and a brief cover letter detailing your interest in the role and relevant experience.

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