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Commission Anthem Utilization Review Jobs (NOW HIRING)

MNCP Staffing

Utilization Review Nurse

Las Vegas, NV · On-site

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

UHS

Utilization Review Manager

Grand Rapids, MI

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 ...

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Commission Anthem Utilization Review information

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

As of Jul 26, 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
What cities are hiring for Commission Anthem Utilization Review jobs? Cities with the most Commission Anthem Utilization Review job openings:
What are the most commonly searched types of Anthem Utilization Review jobs? The most popular types of Anthem Utilization Review jobs are:
What states have the most Commission Anthem Utilization Review jobs? States with the most job openings for Commission Anthem Utilization Review jobs include:
What job categories do people searching Commission Anthem Utilization Review jobs look for? The top searched job categories for Commission Anthem Utilization Review jobs are:
Commission Anthem Utilization Review jobs near you
Infographic showing various Commission Anthem Utilization Review job openings in the United States as of July 2026, with employment types broken down into 1% Internship, 88% Full Time, 10% Part Time, and 1% Contract. Highlights an 98% Physical, 1% Hybrid, and 1% 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

Full-time

Posted 4 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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