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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 ...

Urology Centers of Alabama

Prior Authorization

Homewood, AL · On-site

$18 - $24/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 ...

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Shields Health Solutions

$54.25 - $63.75/hr

This includes referral intake, data entry, claims adjudication support, prior authorization ... Please review our: California Workforce Privacy Notice and Privacy Policy. By providing your mobile ...

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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.

How do I get into a prior authorization utilization review?

To enter a prior authorization utilization review role, candidates typically need a background in healthcare, nursing, or health administration, along with knowledge of insurance policies and medical coding. Relevant certifications such as Certified Professional Coder (CPC) or Certified Utilization Review Professional (CURP) can enhance prospects, and experience with electronic health records (EHR) systems is often required.

Is prior authorization utilization review a stressful job?

Prior authorization utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. The role often involves reviewing medical documentation and making quick decisions, which can lead to pressure and workload challenges, especially during high-volume periods.

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.

Utilization Review Technician

Prime Healthcare

Gadsden, AL • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 5 days ago

Prime Healthcare rating

6.5

Company rating: 6.5 out of 10

Based on 285 frontline employees who took The Breakroom Quiz

605th of 887 rated healthcare providers

Job description

Department: Social Work Services 

Shifts Available: Days  

Employment Type: Full Time 

Hours: 8-hour shift – 7:30am to 3:30pm 

Location: Riverview Regional Medical Center – Gadsden, AL 

We are seeking an Utilization Review Technician II, sometimes referred to as Utilization Management Technician II or Utilization Review Coordinator II. The Utilization Review Technician II supports the utilization review, appeals, and denial management process by coordinating communication and tracking payer-related activity. This role works closely with insurance providers, health plans, Utilization Review teams, the Business Office, and Case Managers to help ensure timely follow-up on authorizations, reviews, appeals, and denials. The position also assists with payer audits, Release of Information, discharge coordination, and other departmental needs. 


  • Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews, appeals, and denials 
  • Document and track all communication attempts with insurance providers and health plans 
  • Follow up on denials while partnering with Utilization Review, Business Office, and Case Management teams 
  • Maintain accurate tracking of government and payer audits, including RAC, MAC, CERT, ADR, QIO, Medicaid, and pre/post-payment reviews 
  • Provide support with Release of Information, discharge coordination, and other assigned departmental duties 

  • High School Diploma or equivalent
  • Two years of relevant experience
  • Accurate alphabetic, numeric, and/or terminal-digit filing skills
  • Computer data entry with 10-key, with accurate typing speed of 35 wpm
  • Associates Degree or higher, preferred
  • Excel skills. highly preferred
  • Knowledge of terminal digit filing and medical terminology, preferred
  • Knowledge of State and Federal regulatory requirements for medical staff documentation, preferred
  • Completion of a medical terminology course, preferred
  • Background in business and office training, preferred

Here are some of the benefits of working at Prime Healthcare: 

  • Health, dental, and vision insurance options 
  • Paid vacation, sick time and holidays 
  • Bereavement leave, FMLA and other leave options 
  • Employer 401K options 
  • Tuition reimbursement options  
  • Life, disability, and other insurance options 
  • Many other amazing benefits 

Full benefits at Prime Healthcare: https://www.primehealthcare.com/careers/benefits/   

#LI-MP1


Full Time
Days

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

 

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