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Authorization Utilization Review Jobs in Washington

Compass Health Center

Intake Therapist

Falls Church, VA

$40K - $45K/yr

Chart and communicate with our utilization review department regarding initial insurance authorizations * Facilitate group therapy and family therapy, as needed (e.g., when intake census is lower ...

Discovery Behavioral Health

Nurse Administrator

Mclean, VA · On-site

$85K - $100K/yr

Participates in the utilization review process and communicates with the nursing team on related patient authorizations. * Audits and ensures the med rooms are compliant with regulatory requirements.

Backpack Healthcare

Clinical Psychologist

Annapolis, MD · On-site

$87K - $120K/yr

... authorized parties. * Prepare clear, timely, and clinically sound reports with diagnostic ... Participate in quality assurance, clinical audits, utilization review, and corrective-action ...

Spring Leaf Solutions

Clinical Manager

Washington, DC · On-site

$72 - $88/hr

... that treatment plan authorizations and reauthorizations, CALOCUS/LOCUS, DLA-20 and updated ... Ensure incident reports are prepared and submitted on time and manage utilization review of CS ...

Springleaf Solutions

Clinical Manager

Washington, DC · On-site

$80K/yr

... that treatment plan authorizations and reauthorizations, CALOCUS/LOCUS, DLA-20 and updated ... Ensure incident reports are prepared and submitted on time and manage utilization review of CS ...

Springleaf Solutions

Clinical Manager

Washington, DC · On-site

$80K/yr

... that treatment plan authorizations and reauthorizations, CALOCUS/LOCUS, DLA-20 and updated ... Ensure incident reports are prepared and submitted on time and manage utilization review of CS ...

Pyramid Healthcare

Counselor

Bowie, MD · On-site

$60K - $70K/yr

Provide documentation and clinical support for utilization review activities and continued stay authorizations. * Participate in discharge planning, aftercare development, and outcome tracking ...

UVA Health

Patient Services Coordinator

Manassas, VA · On-site

$16 - $23.39/hr

Verifies eligibility for patients and ensures all pre-authorizations, referrals, and pre-certifications are obtained as necessary by working closely with the physician offices, Utilization Review and ...

UVA Health

Patient Service Coordinator

Manassas, VA · On-site

$16 - $23.39/hr

Verifies eligibility for patients and ensures all pre-authorizations, referrals, and pre-certifications are obtained as necessary by working closely with the physician offices, Utilization Review and ...

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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 Washington?

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

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

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

Authorization Utilization Review jobs near you
Infographic showing various Authorization Utilization Review job openings in Washington as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 4% Contract, and 1% Nights. Highlights an 86% Physical, 3% Hybrid, and 11% Remote job distribution.

Care Management Assistant - Part-time - DCMC

Luminis Health

Lanham, MD • On-site

Part-time

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

Key responsibilities

  • Assist in the referral process by transmitting patient documentation and verifying receipt.

  • Arrange transportation for patients and document arrangements in the electronic medical record.

  • Provide clerical support to facilitate patient transfers, discharges, and communication among care team members.

Luminis Health rating

7.9

Company rating: 7.9 out of 10

Based on 54 frontline employees who took The Breakroom Quiz

110th of 898 rated healthcare providers

Job description

Position Objective:

Care Management Assistants are administrative professionals who provide direct support to ensure that patients move through the system and receive the treatment and services they require. They are responsible for interacting with Care Management staff, insurance agencies, and post-acute care providers/agencies/facilities to bring all aspects of a patient's care together, including scheduling follow-up appointments, coordinating transportation, referral management, obtaining records, social work and Care management support, and other delegated duties.

Essential Job Duties:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  1. Assists in referral process by transmitting required patient documentation using web-based software system as requested by Care Manager or Social Worker, and verifies the facility received information. Informs Care Manager or Social Worker of authorizations and requests for additional information.
  2. Prepares, completes, and distributes facility transfer packets. Identifies missing documentation and initiates appropriate follow-up to obtain information.
  3. Arranges ambulance and wheelchair van transportation for patients to facilities or home as requested by Care Manager or Social Worker; notifies facility and unit staff of arrangements.  Documents patient choice, ambulance and wheelchair van arrangements in electronic medical record.
  4. Facilitates effective exchange of information with post-acute facility liaisons, home care liaisons and DME suppliers. This includes notification of the Care Manager or Social Worker of any identified concern or delay in placement or post discharge supplies.
  5. Uses problem solving skills to avoid delays, ex. late transportation. Coordinates with the Care Manager, Social Worker or other personnel as needed.
  6. Deliver patient notification letters as needed----Notice of Observation Status, MOON, Important Message from Medicare and others. Obtains the appropriate signature and uploads into the electronic record.
  7. Assists in obtaining authorizations for transition to the next level of care (i.e., home, acute/subacute rehab facility, transportation, DME, etc.).
  8. Provides clerical and support functions to the Care management staff members with the goal of promoting expeditious patient transfers and/or discharges.
  9. Establishes and promotes positive and collaborative working relationships with Care Managers (CM), Social Workers (SW), Utilization Review Nurses, and administrative staff to facilitate discharge planning.
  10. Assists in the administration of Care Management functions to include, but not limited to -organization of workflow, communications, links to community resources, and other duties to assist in the facilitation of discharges.

Educational/Experience Requirements:

  • Bachelor's degree plus one year of related experience, or high school diploma or equivalent and three years related work experience.
  • Experience in care coordination, Care management, disease management, hospital/acute care setting, or customer service preferred.
  • Knowledge of State and Local regulations, community resources, discharge planning, insurance verification, financial counseling, and/or medical billing a plus.
  • Ability to communicate effectively, required.

What Luminis Health employees say

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