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Prior Authorization Utilization Review Jobs (NOW HIRING)

24-MAG LLC

Utilization Review Specialist

Manhattan, NY · Remote

$80/hr

Review end-to-end prior authorization workflows for medical and clinical services across multiple ... and utilization management judgmentEvaluate outputs for alignment with payer requirements, CMS ...

24-MAG LLC

Utilization Review Specialist

Manhattan, NY · Remote

$80/hr

Review end-to-end prior authorization workflows for medical and clinical services across multiple ... and utilization management judgmentEvaluate outputs for alignment with payer requirements, CMS ...

Socket.dev

Utilization Review Specialist

Indianapolis, IN · On-site

$60 - $80/hr

The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Initiate, prepare, submit, and track prior authorization requests for specialty medications through ...

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How much do prior authorization utilization review jobs pay per hour?

As of Sep 6, 2026, the average hourly pay for prior 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 is a Prior Authorization Utilization Review specialist?

A Prior Authorization Utilization Review specialist is a healthcare professional responsible for evaluating medical service requests to ensure they meet specific criteria for approval before services are provided. Their main role is to review clinical information, verify medical necessity, and ensure compliance with insurance policies and guidelines. They act as a liaison between healthcare providers, insurance companies, and patients to facilitate timely and accurate authorization decisions. This process helps to manage healthcare costs and ensure patients receive appropriate care.

What are the key skills and qualifications needed to thrive as a Prior Authorization Utilization Review specialist?

To thrive as a Prior Authorization Utilization Review Specialist, you need a strong understanding of medical terminology, insurance guidelines, and clinical criteria, often supported by a degree in healthcare or nursing and relevant certification (such as RN or LPN). Familiarity with prior authorization software, electronic health record (EHR) systems, and payer portals is typically required. Attention to detail, strong communication skills, and the ability to multitask help professionals excel in this role. These competencies ensure accurate and timely processing of authorizations, reducing delays in patient care and ensuring compliance with payer requirements.

What are some common challenges faced by professionals in Prior Authorization Utilization Review roles, and how can these be managed?

Professionals in Prior Authorization Utilization Review often encounter challenges such as navigating complex insurance policies, managing high volumes of requests, and ensuring timely communication between providers and payers. Staying organized, developing a thorough understanding of payer guidelines, and maintaining clear, consistent communication are key strategies for managing these challenges. Many teams also rely on workflow management tools and regular team huddles to streamline processes and ensure all cases are handled efficiently.

What is the difference between Prior Authorization Utilization Review vs Medical Reviewer?

AspectPrior Authorization Utilization ReviewMedical Reviewer
CredentialsLicensed healthcare professionals, often with certifications in utilization reviewLicensed physicians or healthcare providers with clinical expertise
Work EnvironmentInsurance companies, healthcare organizations, or third-party review firmsHospitals, clinics, insurance companies, or consulting firms
Primary FocusAssessing the necessity of procedures or treatments before approvalEvaluating clinical records to determine medical necessity and appropriateness

While both roles involve clinical assessment, Prior Authorization Utilization Review focuses on pre-authorization decisions for treatments, whereas Medical Review involves detailed clinical evaluation of patient records to determine medical necessity. Both require healthcare credentials and are integral to healthcare quality and cost management.

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Prior Authorization Utilization Review jobs near you
Infographic showing various Prior Authorization Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 18% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

UTILIZATION REVIEW / PRIOR AUTHORIZATION SPECIALIST

Golden Age Foundation, Inc

Charlotte, NC

$20 - $40/hr

Full-time

Posted 12 days ago

Job description

Join Our Team as a Utilization Review / Prior Authorization Specialist

Are you passionate about making a difference in the lives of individuals and communities? At Golden Age Foundation, we’re redefining how support is provided by creating a whole-person, ecosystem-based network of care. If you’re ready to contribute to a mission-driven organization that builds pathways to stability, purpose, and independence, we’d love to hear from you!

About Golden Age Foundation

Golden Age Foundation is on a mission to transform the way individuals, children, families, and communities access care and opportunity. By bridging the gaps between mental health, reentry, family support, education, employment, housing, and more, we create an interconnected ecosystem designed to help people heal, rebuild, and thrive.

We don’t just treat problems—we empower people to achieve generational progress and independence. Join our team and be part of a groundbreaking approach to community support!

Position Summary

As a Utilization Review / Prior Authorization Specialist, you will play a vital role in ensuring individuals receive the care and services they need. You’ll be responsible for reviewing cases, coordinating authorizations, and working closely with our team to support the delivery of high-quality care. This is an opportunity to make a meaningful impact while contributing to a mission-driven organization.

Key Responsibilities
  • Conduct utilization reviews to evaluate the appropriateness of care and services.
  • Process and manage prior authorization requests in a timely and accurate manner.
  • Collaborate with healthcare providers, insurance companies, and internal teams to ensure seamless service delivery.
  • Maintain detailed and accurate documentation of reviews and authorizations.
  • Stay up-to-date with relevant policies, procedures, and regulations.
Required Skills and Qualifications
  • At least 1 year of experience in utilization review, prior authorization, or a related field.
  • Strong organizational and time-management skills to handle multiple tasks efficiently.
  • Excellent communication skills, both written and verbal, to interact with diverse stakeholders.
  • Attention to detail and the ability to analyze information critically.
  • Familiarity with healthcare systems, insurance processes, and regulatory guidelines is a plus.
Why Join Golden Age Foundation?

While we do not currently offer additional benefits, we provide the opportunity to be part of a team that is reshaping how communities access support. At Golden Age Foundation, your work will directly contribute to building pathways for individuals and families to achieve stability, purpose, and independence.

Our Culture and Values

At Golden Age Foundation, we value collaboration, innovation, and compassion. Our team is dedicated to creating a supportive environment where everyone can thrive. We believe in the power of connection and are committed to making a lasting impact in the lives of those we serve.

Ready to Make a Difference?

If you’re ready to bring your expertise and passion to a forward-thinking organization, we’d love to hear from you! Apply today and join us in building a brighter future for individuals, families, and communities.


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