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Authorization Utilization Review Jobs (NOW HIRING)

Umpqua Health

Utilization Review Specialist

Winston, OR · On-site

$41K - $47K/yr

Track prior authorization requests using established systems to ensure timely processing. * Support timely notification of prior authorization determinations. * Coordinate daily workflow and ...

The Meadows

Utilization Review Coordinator

Phoenix, AZ · On-site +1

As the Utilization Review Coordinator, you will develop and implement systems for authorizations ... Monitor each step of the authorization process to proactively identify potential problems and ...

Sheppard Pratt

Utilization Review Specialist

Towson, MD · On-site

$26.04/hr

Responsible for supporting the utilization review system including data analysis, report writing ... Also responsible for securing authorizations and tracking entitlements for enrolled clients.

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How much do authorization utilization review jobs pay per hour?

As of Jul 13, 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 are the key skills and qualifications needed to thrive as an Authorization Utilization Review Specialist, and why are they important?

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.
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Authorization Utilization Review jobs near you
Infographic showing various Authorization Utilization Review job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 88% Full Time, 10% Part Time, and 1% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Specialist

Parkside Hospital

Tulsa, OK

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 6 days ago

Job description

Parkside provides professional purpose, hope, and healing. As a member of our staff, you will be part of a mission-driven team, dedicated to changing lives and changing communities, one patient at a time. 

Parkside Psychiatric Hospital & Outpatient Clinic is a comprehensive mental healthcare system providing acute inpatient care, residential treatment, and outpatient therapy. With a focus on society’s most vulnerable population, Parkside provides world-class mental health services for youth and adults. For over 65 years, Parkside’s physicians, therapists, and staff have provided state of the art, patient-centered care that propels families from hopeful to hope-filled. As a center of excellence, we cultivate talent and provide professional purpose. Together we facilitate healing, one patient at a time. 

We are looking for a Full Time Utilization Review Specialist! The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to limit possible recoupment from third party pay sources including Medicare, Medicaid, HMO or private insurance. Coordinates with clinicians, business office and medical records to achieve above goals.

Responsibilities:

• Prepares authorization paperwork, processes requests for authorizations, and reviews requests for accuracy.

• Communicates with clinicians regarding discharge issues relevant to patient’s pay source. Tracks due dates for authorization reviews and alerts clinicians.

• Communicates with clinicians regarding admissions and discharges to various units.

• Knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage. Maintains current knowledge of managed care requirements and accurately interprets these requirements to increase authorizations.

• Coordinates/completes the appeal process for authorization denials

• Performs audits of clinical services to ensure compliance with standards of third party pay sources and agency policies.

• Tracks unauthorized services and possible recoupment issues. Looks for possible corrections, trends.

 • Maintains a good working relationship within the department and with other departments.

• Documentation meets current standards and policies.

 • Maintains fit for duty. Acts in a professional manner and follows all Parkside policies and procedures.

• Orients new staff members to the unit

• Demonstrates the ability to be organized and flexible, acts appropriately in stressful/emergency situations. Able to provide Handle with Care when needed

• Performs other duties as assigned

  • Bachelor’s degree in related field from an accredited university required. Experience in lieu of Degree will be considered.
  • 2yrs minimal experience in health care, utilization review and business setting

Benefits include:

  • Medical, Dental, and Vision
  • Generous Paid Time Off and Holidays
  • 401K and match start immediately, and includes a generous match
  • Company Paid Life Insurance and Disability and more!

We are an Equal Opportunity Employer! 

Apply