ZipRecruiter

Log In

1

Authorization Utilization Review Jobs (NOW HIRING)

RECAP INC

Utilization Review Specialist

Middletown, NY · On-site

$27 - $34/hr

Monitor authorization expiration dates and ensure uninterrupted coverage for clients. * Coordinate peer-to-peer reviews, reconsiderations, and appeals for denied or reduced services. * Maintain ...

Acrisure, LLC

## Utilization Review NurseApplyremote type: Hybridlocations: 1301 6th Ave W - BRADENTON, FLposted on ... authorized at the nurse level, and refers requests for physician review when additional clinical ...

Acrisure, LLC

Utilization Review Nurse

Bradenton, FL · On-site

## Utilization Review NurseApplyremote type: Hybridlocations: 1301 6th Ave W - BRADENTON, FLposted on ... authorized at the nurse level, and refers requests for physician review when additional clinical ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

... authorized at the nurse level, and refers requests for physician review when additional clinical ... Experience in utilization review or case management is highly beneficial, particularly within ...

Socket.dev

Utilization Review Specialist

Knoxville, TN · On-site

The Utilization Review Specialist plays a critical role in ensuring that healthcare services ... Familiarity with insurance authorization processes and healthcare reimbursement models. * Excellent ...

ADP, Inc.

Utilization Review Specialist

Knoxville, TN · On-site

The Utilization Review Specialist plays a critical role in ensuring that healthcare services ... Familiarity with insurance authorization processes and healthcare reimbursement models. * Excellent ...

Acrisure

Utilization Review Nurse

Bradenton, FL

... authorized at the nurse level, and refers requests for physician review when additional clinical ... Experience in utilization review or case management is highly beneficial, particularly within ...

Acrisure LLC

Utilization Review Nurse

Bradenton, FL · On-site

... authorized at the nurse level, and refers requests for physician review when additional clinical ... Experience in utilization review or case management is highly beneficial, particularly within ...

previous pagenext page

Showing results 21-40

All JobsAuthorization Utilization Review Jobs

Authorization Utilization Review information

See salary details

$21

$42

$68

How much do authorization utilization review jobs pay per hour?

As of Sep 15, 2026, the average hourly pay for authorization utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

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.

More about Authorization Utilization Review jobs

What cities are hiring for Authorization Utilization Review jobs?

Cities with the most Authorization Utilization Review job openings:

What states have the most Authorization Utilization Review jobs?

States with the most job openings for Authorization Utilization Review jobs include:

What are popular job titles related to Authorization Utilization Review jobs?

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

Authorization Utilization Review jobs near you
Infographic showing various Authorization Utilization Review job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 81% Full Time, 16% Part Time, and 2% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Specialist

Middletown, NY • On-site

RECAP INC
Finance and Insurance • 1 - 10 employees
Learn more about RECAP INCexternal

$27 - $34/hr

Full-time

Posted 18 days ago

Job description

Join a mission-driven organization dedicated to providing high-quality, person-centered care for individuals with substance use disorders. The agency operates two New York State OASAS-certified programs: a Part 820 Residential Reintegration Program and a Part 822 Outpatient Rehabilitation Program. As a Utilization Review Specialist, you will play a vital role in ensuring that clinical services are medically necessary, appropriately authorized, and compliant with all regulatory and payer requirements. This position offers the opportunity to collaborate with a multidisciplinary team, support quality improvement initiatives, and help maximize access to care for those in need.

Responsibilities
  • Obtain initial, concurrent, and continued stay authorizations from Medicaid Managed Care Organizations and commercial insurance plans.
  • Conduct comprehensive reviews of clinical documentation to ensure compliance with medical necessity, ASAM Criteria, and OASAS regulations.
  • Monitor authorization expiration dates and ensure uninterrupted coverage for clients.
  • Coordinate peer-to-peer reviews, reconsiderations, and appeals for denied or reduced services.
  • Maintain accurate authorization tracking logs and document all utilization review activities in the electronic health record.
  • Collaborate with clinical, medical, and administrative staff to ensure treatment plans and documentation support payer requirements and regulatory standards.
  • Assist clinicians in strengthening documentation and provide feedback on best practices.
  • Participate in internal quality assurance, utilization review, and quality improvement initiatives.
  • Support revenue cycle management by ensuring services are properly authorized and investigating discrepancies affecting reimbursement.
  • Attend multidisciplinary team meetings and serve as a resource on payer requirements and medical necessity criteria.
  • Assist with regulatory readiness, including preparation for OASAS certification reviews and audits.
  • Maintain confidentiality in accordance with HIPAA and 42 CFR Part 2.
  • Perform additional duties as assigned.
Qualifications
  • Bachelor's degree in Social Work, Psychology, Human Services, Nursing, or a related behavioral health field required; Master's degree preferred.
  • One of the following credentials required: LMSW, LCSW, LMHC, CASAC, CASAC-AC, CASAC-MC, RN, or other qualified health professional recognized by NYS OASAS.
  • Minimum of three years of experience in behavioral health or substance use disorder treatment.
  • At least two years of experience in utilization review, case management, quality improvement, or managed care preferred.
  • Experience working in an OASAS-certified program strongly preferred.
  • Experience with Medicaid Managed Care and commercial insurance plans required.
  • Knowledge of ASAM Criteria required.
  • Strong clinical assessment and documentation review skills.
  • Excellent written and verbal communication skills.
  • Ability to analyze clinical documentation for regulatory compliance.
  • Strong organizational and time management skills, with the ability to prioritize multiple deadlines.
  • Proficiency in electronic health records and Microsoft Office applications.
  • Ability to sit for prolonged periods and use computers and office equipment; occasional lifting up to 20 pounds.
  • Ability to travel between agency locations as required.