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Intern Insurance Utilization Review Jobs in New Jersey

ABHS

Utilization Review Specialist

Evesham, NJ · On-site

$55K - $65K/yr

General Description The Utilization Review Specialist processes all insurance authorizations for partial hospitalization programs, intensive outpatient programs and outpatient programs across ...

Winston Staffing

Utilization Review Nurse

Newark, NJ · On-site

100% remote but would need to go to Newark, NJ first day to pick up equipment and orientation Review insurance claims · Analyze medical records and documentation · Compare cases with clinical ...

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Intern Insurance Utilization Review information

What does an intern insurance utilization review do?

An Intern Insurance Utilization Review assists with evaluating medical records and insurance claims to ensure that healthcare services are medically necessary and covered by insurance policies. They work under supervision to review documentation, communicate with healthcare providers, and help determine if treatments meet established guidelines. This role provides valuable exposure to the insurance and healthcare industries, helping interns learn about claims processing, policy compliance, and the importance of cost-effective care.

What skills and qualifications are needed to thrive as an intern insurance utilization review?

To thrive as an Intern in Insurance Utilization Review, you typically need a background in healthcare administration or a related field, along with strong analytical and organizational skills. Familiarity with electronic health records (EHRs), insurance databases, and claims processing systems is often required. Attention to detail, effective communication, and the ability to collaborate with both clinical and administrative teams are essential soft skills. These competencies ensure accurate review of insurance claims, compliance with regulations, and efficient coordination between healthcare providers and insurers.

What is the difference between Intern Insurance Utilization Review vs Insurance Claims Processor?

AspectIntern Insurance Utilization ReviewInsurance Claims Processor
CredentialsTypically pursuing or holding a relevant degree (e.g., health administration, nursing)High school diploma or equivalent; some roles may require insurance or claims processing certifications
Work EnvironmentHealthcare settings, insurance companies, or administrative officesInsurance companies, healthcare providers, or claims processing centers
Primary ResponsibilitiesAssisting in reviewing medical necessity, supporting utilization review processesProcessing and reviewing insurance claims for accuracy and completeness

Intern Insurance Utilization Review focuses on evaluating medical necessity and supporting healthcare decision-making, often involving review of patient records. Insurance Claims Processors handle the administrative task of reviewing and processing insurance claims for payment. While both roles involve insurance and healthcare, utilization review emphasizes clinical assessment, whereas claims processing centers on administrative claim management.

How do I get into an intern insurance utilization review?

To become an intern in insurance utilization review, candidates typically need to be enrolled in or have recently completed a relevant healthcare or insurance-related program, such as health administration or nursing. Gaining knowledge of medical terminology, insurance policies, and utilization review processes, along with strong analytical skills, is important; some positions may require certification or training in healthcare quality or case management. Internships are often offered through insurance companies, healthcare organizations, or hospitals and may require applying through their career portals or internship programs.

Is utilization review a stressful job?

Utilization review as an intern involves evaluating insurance claims and determining appropriate care, which can be demanding due to strict deadlines and the need for accuracy. The role requires attention to detail and knowledge of insurance policies, but stress levels vary depending on workload and individual coping skills.

What are the most commonly searched types of Insurance Utilization Review jobs in New Jersey?

The most popular types of Insurance Utilization Review jobs in New Jersey are:

What cities in New Jersey are hiring for Intern Insurance Utilization Review jobs?

Cities in New Jersey with the most Intern Insurance Utilization Review job openings:

Intern Insurance Utilization Review jobs near you

Utilization Review

Discovery Institute of Addictive Disorders Inc.

Marlboro, NJ • On-site

Full-time

Re-posted 12 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.