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Commission Anthem Utilization Review Jobs (NOW HIRING)

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

Job Summary Our client is seeking a Utilization Review Nurse to manage the full lifecycle of ... Any required state or Joint Commission training is compensated at the state or local minimum wage ...

Medix

Utilization Review Nurse

Fort Worth, TX · On-site

$38.46 - $43.27/hr

Job Summary Our client is seeking a skilled Utilization Review Nurse to join their team. This role ... Any required state or Joint Commission training is compensated at the state or local minimum wage ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

We are licensed by the State of Michigan, fully accredited by The Joint Commission and we bring ... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

We are licensed by the State of Michigan, fully accredited by The Joint Commission and we bring ... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

We are licensed by the State of Michigan, fully accredited by The Joint Commission and we bring ... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ...

CHI Health

Utilization Review RN

Omaha, NE · On-site

$33.51 - $48.58/hr

Job Summary and Responsibilities As our Utilization Review RN, you will play a pivotal role in ... Commission standards while supporting the overall progression of care for our diverse patient ...

UHS

Utilization Review Nurse (RN)

Augusta, GA · On-site

We provide a carefully-structured and supportive environment, and our education program is accredited through the Georgia Accrediting Commission. Utilization Review Nurse . Under the direction of the ...

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Commission Anthem Utilization Review information

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$21

$42

$68

How much do commission anthem utilization review jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for commission anthem 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 the difference between Commission Anthem Utilization Review vs Commission Anthem Claims Processor?

AspectCommission Anthem Utilization ReviewCommission Anthem Claims Processor
CertificationsTypically requires healthcare or insurance-related certificationsUsually requires claims processing or insurance administration certifications
Work EnvironmentHealthcare facilities, insurance companies, or remoteInsurance offices, call centers, or remote
Employer & Industry UsageUsed in healthcare and insurance sectors for review of medical necessityUsed in insurance companies for processing claims and payments

While both roles are part of the insurance industry, Commission Anthem Utilization Review focuses on evaluating the necessity of medical services, whereas Commission Anthem Claims Processor handles the processing and payment of insurance claims. Understanding these differences helps clarify job responsibilities and required skills in the insurance sector.

More about Commission Anthem Utilization Review jobs

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Commission Anthem Utilization Review jobs near you
Infographic showing various Commission Anthem Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review

Discovery Institute of Addictive Disorders Inc.

Marlboro, NJ • On-site

Full-time

Re-posted 11 days ago

Key responsibilities

  • Obtain initial and concurrent insurance authorizations for all levels of care.

  • Review clinical documentation to ensure it supports medical necessity and submit required information to insurance companies within specified timeframes.

  • Monitor authorization expiration dates, communicate decisions to clinical staff, and prepare and submit appeals for denied services.

Job description

Position Summary

The Utilization Review (UR) Specialist is responsible for obtaining and maintaining insurance authorizations for clients receiving substance use disorder treatment services. This position works closely with clinical staff, admissions, and insurance companies to ensure medical necessity documentation is accurate, authorizations are obtained timely, and reimbursement is maximized while maintaining compliance with payer requirements, Medicaid regulations, and accreditation standards.

Essential Duties and Responsibilities
  • Obtain initial and concurrent insurance authorizations for all levels of care.
  • Review clinical documentation to ensure it supports medical necessity.
  • Submit clinical information to insurance companies within required timeframes.
  • Monitor authorization expiration dates and request extensions before expiration.
  • Communicate authorization decisions and payer requirements to clinical staff.
  • Track approved days and notify leadership of denials or reductions in care.
  • Prepare and submit appeals for denied services when appropriate.
  • Maintain accurate authorization records in the electronic health record (EHR).
  • Work collaboratively with Admissions, Clinical, Nursing, and Billing departments.
  • Verify insurance benefits and coverage when necessary.
  • Monitor payer portals for authorization updates.
  • Assist with Medicaid and managed care authorization processes.
  • Participate in utilization review meetings and case conferences.
  • Generate reports on authorization status, denials, appeals, and payer trends.
  • Ensure compliance with Joint Commission, state, federal, and payer regulations.
  • Maintain confidentiality in accordance with HIPAA regulations.
  • Perform other duties as assigned.
Qualifications
  • High school diploma required; Associate's or Bachelor's degree preferred.
  • Minimum of two years of utilization review, case management, medical billing, or behavioral healthcare experience preferred.
  • Experience in substance use disorder or behavioral health treatment strongly preferred.
  • Knowledge of ASAM Criteria preferred.
  • Familiarity with Medicaid, commercial insurance, and managed care plans.
  • Strong organizational and time management skills.
  • Excellent verbal and written communication skills.
  • Ability to prioritize multiple cases in a fast-paced environment.
  • Proficient in Microsoft Office and electronic health record systems.
Knowledge, Skills, and Abilities
  • Understanding of insurance authorization processes.
  • Knowledge of medical necessity criteria and documentation standards.
  • Strong analytical and critical thinking skills.
  • Excellent customer service and professional communication.
  • Ability to work independently while collaborating with interdisciplinary teams.
  • Attention to detail and accuracy.
  • Ability to maintain confidentiality.
Performance Expectations
  • Maintain timely insurance authorizations with minimal lapses.
  • Reduce avoidable authorization denials.
  • Ensure documentation meets payer standards.
  • Maintain accurate records and reporting.
  • Demonstrate professionalism, teamwork, and excellent customer service.
  • Comply with all organizational policies, HIPAA, Joint Commission standards, and applicable federal and New Jersey regulations.