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Commission Anthem Utilization Review Jobs (NOW HIRING)

Discovery Institute

Utilization Review

Marlboro, NJ · On-site

Position Summary The Utilization Review (UR) Specialist is responsible for obtaining and ... Ensure compliance with Joint Commission, state, federal, and payer regulations. * Maintain ...

Tuba City Regional

Utilization Review

Tuba City, AZ · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

RN - Utilization Review Ready for your next adventure? Axis Medical Staffing, one of the leading ... Joint Commission certified since 2007 Perks of being an Axis Rock Star * Weekly pay with ...

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Strong knowledge of Joint Commission and CMS guidelines Why Apply * Competitive pay * Stable, high-demand role * Collaborative healthcare environment Apply Now If you have strong Utilization Review ...

Banyan

Utilization Review Specialist

Pompano Beach, FL · On-site

$50K - $65K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Utilization Review Specialist | Remote | Full-Time $50,000 - $65,000 Annually | Weekdays (Weekend ... Nationally recognized organization - Joint Commission-accredited, with 18 locations and telehealth ...

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

About the job Utilization Review Nurse Sign on bonus may apply up to $15,000 Position Summary ... Joint Commission Accredited Health care Organizations standards, state statutes governing hospital ...

Lifepoint Health

Utilization Review Specialist

Tucson, AZ · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

As a Utilization Review Specialistjoining our team, you're embracing a vital mission dedicated to ... Accredited by The Joint Commission and certified by CMS, El Dorado Springs Behavioral Health is ...

Lifepoint Health

Utilization Review Specialist

Tucson, AZ

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

As a Utilization Review Specialistjoining our team, you're embracing a vital mission dedicated to ... Accredited by The Joint Commission and certified by CMS, El Dorado Springs Behavioral Health is ...

Mission Hospital

RN - Utilization Review

Tuba City, AZ · On-site

$2.5K/wk

Ensure that utilization review practices comply with regulatory standards, including The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), and other state or federal regulations ...

MNCP Staffing

Utilization Review Nurse

Las Vegas, NV

Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance ... Joint Commission Accredited Health care Organizations standards, state statutes governing hospital ...

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

  • Medical

  • Dental

  • Vision

  • Retirement

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

Southfield, MI · On-site

$42 - $46/hr

  • Medical

  • Dental

  • Vision

  • Retirement

Job Summary Our client is seeking a Utilization Review Nurse. This role involves managing the full ... Any required state or Joint Commission training is compensated at the state or local minimum wage ...

St. Luke's Health

Utilization Review RN

Houston, TX · On-site

Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for ...

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All JobsAnthem Utilization Review JobsCommission Anthem Utilization Review Jobs

Commission Anthem Utilization Review information

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

As of Aug 16, 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.

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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, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review

Discovery Institute NJ

Marlboro, NJ • On-site

Other

Posted 23 days ago

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.

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