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Prior Authorization Utilization Review Jobs in Alabama

Urology Centers of Alabama

Prior Authorization

Birmingham, AL · On-site

$16.75 - $22.50/hr

This role involves reviewing payer requirements, gathering appropriate clinical documentation, and ... Track and update prior authorization requests and outcomes using internal tracking tools and ...

OneOncology LLC

Prior Authorization Specialist

Huntsville, AL · On-site

$17.75 - $23.75/hr

Ability to navigate Health Plan websites for medical policy review regarding services. * Must be ... Prior Authorization experience preferred Working conditions This position works in the billing ...

OneOncology LLC

Prior Authorization Specialist

Huntsville, AL · On-site

$17.75 - $23.75/hr

Ability to navigate Health Plan websites for medical policy review regarding services. * Must be ... Prior Authorization experience preferred Working conditions This position works in the billing ...

OneOncology LLC

Prior Authorization Specialist

Huntsville, AL · On-site

$17.75 - $23.75/hr

Ability to navigate Health Plan websites for medical policy review regarding services. * Must be ... Prior Authorization experience preferred Working conditions This position works in the billing ...

OneOncology LLC

Prior Authorization Specialist

Huntsville, AL · On-site

$17.75 - $23.75/hr

Ability to navigate Health Plan websites for medical policy review regarding services. * Must be ... Prior Authorization experience preferred Working conditions This position works in the billing ...

OneOncology

Prior Authorization Manager

Huntsville, AL · On-site

Conduct comprehensive reviews of oncology/hematology treatment plans and patient medical records to determine appropriate prior authorization requests based on clinical guidelines, payer policies ...

Astera Cancer Care

$85 - $110/hr

... reviews of oncology/hematology treatment plans and patient medical records to determine appropriate prior authorization requests based on clinical guidelines, payer policies, and treatment ...

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Prior Authorization Utilization Review information

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.

What are popular job titles related to Prior Authorization Utilization Review jobs in Alabama?

For Prior Authorization Utilization Review jobs in Alabama, the most frequently searched job titles are:

What job categories do people searching Prior Authorization Utilization Review jobs in Alabama look for?

The top searched job categories for Prior Authorization Utilization Review jobs in Alabama are:

What cities in Alabama are hiring for Prior Authorization Utilization Review jobs?

Cities in Alabama with the most Prior Authorization Utilization Review job openings:

Prior Authorization Utilization Review jobs near you
Infographic showing various Prior Authorization Utilization Review job openings in Alabama as of August 2026, with employment types broken down into 89% Full Time, and 11% Part Time. Highlights an 100% In-person job distribution.

Prior Authorization

Urology Centers of Alabama

Birmingham, AL • On-site

$16.75 - $22.50/hr

Full-time

Re-posted 21 days ago

Job description

General Summary

The Prior Authorization Specialist coordinates and secures insurance authorization for medications, in-office injections, and imaging when needed to support timely patient care. This role involves reviewing payer requirements, gathering appropriate clinical documentation, and communicating with insurance companies, pharmacies, and internal staff to facilitate authorization approvals. The ideal candidate demonstrates strong time management, attention to detail, integrity, and the ability to manage multiple requests while maintaining organization and professionalism in a high-volume environment. 

Key Responsibilities 

  • Complete authorization submissions through electronic platforms, payer portals, and telephone communications with insurance representatives when required. 

  • Review patient charts to obtain relevant clinical documentation needed to support authorization requests 

  • Communicate professionally with insurance companies, pharmacies, patients, and internal staff regarding authorization requirements and status updates. 

  • Track and update prior authorization requests and outcomes using internal tracking tools and insurance portals to ensure timely processing and follow-up. 

  • Demonstrate accountability for assigned authorization requests by monitoring status and following up with payers when necessary.  

  • Actively monitor PA Pool and EHR inbox communications to ensure timely response to authorization requests and related inquiries. 

  • Ensure all prior authorization submissions and supporting documentation accurately reflect the patient’s medical record and comply with payer requirements. 

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; stoop, kneel, crouch, or crawl; and talk or hear.  The employee must occasionally lift and/or move more than 45 pounds.

  • Familiarity with medical terminology and working knowledge of medical coding systems (CPT, ICD-10) relevant to prior authorization requests. 

  • Strong organizational and time management skills, with the ability to prioritize urgent requests and meet deadlines in a high-volume environment. 

  • Excellent written and verbal communication skills when interacting with patients, insurance representatives, pharmacies, and internal clinical staff. 

  • Ability to work both independently and collaboratively within a team while managing multiple tasks simultaneously. 

  • Demonstrates integrity, professionalism, and ethical decision-making when handling patient information and submitting prior authorization requests. 

  • HS Diploma or GED  required. 

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