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Sevita

Utilization Review Specialist

Akron, OH · On-site

$40.17K/yr

SUMMARY The Utilization Review Specialist is responsible for proactive planning measures, accurate ... Provides professional oversight of service delivery authorizations and assurances, effective ...

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How much do authorization utilization review jobs pay per hour?

As of May 31, 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 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 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.

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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 job categories do people searching Authorization Utilization Review jobs look for? The top searched job categories for Authorization Utilization Review jobs are:
Authorization Utilization Review jobs near you
Infographic showing various Authorization Utilization Review job openings in the United States as of May 2026, with employment types broken down into 1% As Needed, 88% Full Time, 9% Part Time, and 2% Contract. Highlights an 80% Physical, 15% Hybrid, and 5% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Assistant- Remote

Utilization Review Assistant- Remote

Hurley Medical Center

Flint, MI • On-site, Remote

Full-time

Posted 3 days ago

Hurley Medical Center rating

6.9

Company rating: 6.9 out of 10

Based on 27 frontline employees who took The Breakroom Quiz

524th of 990 rated hospitals

Job description

Job Description
This position will assist in the coordination of all activities related to insurance authorizations process for the Patient Access Utilization Review (UR) department. Activities may consist of collaborating with various medical staff and Medical Center personnel, participating in non-clinical appeals process, obtaining status updates on all outstanding appeals, monitoring and tracking of all financial activities related to the UR team. Participates in quality management and continuous quality improvement activities. Perform all job duties and responsibilities in a courteous and customer-focused manner according to the Hurley Family Standards of Behavior. Works under the direction of the Director of Patient Access or designee who reviews work for effectiveness and compliance with established standards, policies, and procedures.
Responsibilities
  1. Perform necessary authorization-related tasks in an accurate and timely manner. This includes utilization of the Epic EMR system efficiently and effectively and providing sufficient and clear documentation of all actions taken.
  2. Assist in the initial authorization approval process by communicating with various payers and other internal Medical Center personnel and submitting pertinent documentation to the payers for approval consideration.
  3. Assist in submitting concurrent and retrospective reviews to appropriate payers. This may require following up with physicians and other health care providers to review admissions and continued stays not meeting criteria.
  4. Stay abreast of health care benefit inclusions and exclusions for all financial classes, benefit changes, review requirements, and other pertinent regulations influencing the Medical Center.
  5. Assist with appeals of denied days by third-party reviewers throughout each stage of available reconsideration/appeal mechanisms.
  6. Review charts for instances of over/under utilization of ancillary services to ensure optimum quality of care and maximum reimbursement.
  7. Collaborate with the Patient Access/Registration, Medical Records, Billing teams, and other hospital areas to ensure post discharge completion of all information necessary to generate timely billing.
  8. Assist in drafting letters to third-party review entities and medical staff members and working with the Utilization Review Coordinators for approval and finalization of such letters.
  9. Assist in identification, development, and implementation of new procedures designed to increase operating efficiency.
  10. Review level of care for patients (with UR Coordinators and medical staff approval) regarding inpatient, observation, and outpatient care and relate this information to the Revenue Cycle teams for billing purposes.
  11. Maintain all primary assignments (based on financial goals assigned to the UR department). This consists of working on Discharge Not Billed (DNB), Claim Edits, and Stop Bill work queues or reports to accomplish timely accounts resolution.
  12. Perform other related duties as required/assigned. Utilizes new improvements and/or technologies that relate to job assignment.

Qualifications
  • Associate's degree in healthcare or related field required (Bachelor's degree preferred).
  • Two (2) years of healthcare experience in authorizations, coding, patient registration, billing, or utilization review.
  • Knowledge of hospital patient care admission processes and third party payer utilization requirements.
  • Strong background and knowledge of payer authorizations and referrals.
  • Ability to communicate effectively in oral and written modes.
  • Ability to interact courteously and effectively with all levels of the Medical Center staff, patients, medical staff, external agency representatives, and the public.

NOTE: If the incumbent is skillfully prepared and actively pursuing a degree, they will be required to obtain minimally an Associate's degree within one (1) year of accepting the position.

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