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Prior Authorization Utilization Review Jobs in Arizona

Arizona Priority Care

Prior Authorization Rep

Chandler, AZ · Hybrid

$39K - $54K/yr

... entry, reviewing historical utilization management history to include program enrollment and ... prior authorization request (provider loads, out of network (OON) credentialing, accreditation ...

Foothills Neurology

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Botox Prior Authorization

Phoenix, AZ · On-site

$20 - $25/hr

A Botox Prior Authorization Specialist secures insurance approval for therapeutic Botox injections ... Review medical records for diagnosis codes (e.g., ICD-10 for chronic migraine, dystonia) and submit ...

Arizona State Hospital

Job Page

Phoenix, AZ · On-site

$71K/yr

Behavioral Health Prior Authorization Utilization Review Consultant Division of Fee for Service Management (DFSM) Job Location: Address: 150 North 18th Avenue Phoenix, Arizona 85007 This position may ...

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Prior Authorization Utilization Review information

What are the key skills and qualifications needed to thrive as a Prior Authorization Utilization Review Specialist, and why are they important?

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 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 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 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 are popular job titles related to Prior Authorization Utilization Review jobs in Arizona? For Prior Authorization Utilization Review jobs in Arizona, the most frequently searched job titles are:
What job categories do people searching Prior Authorization Utilization Review jobs in Arizona look for? The top searched job categories for Prior Authorization Utilization Review jobs in Arizona are:
Prior Authorization Utilization Review jobs near you
Infographic showing various Prior Authorization Utilization Review job openings in Arizona as of July 2026, with employment types broken down into 93% Full Time, and 7% Part Time. Highlights an 65% In-person, 14% Hybrid, and 21% Remote job distribution.

Botox Utilization Review Specialist - Phoenix, AZ

HealthOp Solutions

Phoenix, AZ • On-site

$20 - $25/hr

Full-time

Re-posted 27 days ago

Job description

Job Title: Botox Utilization Review Specialist

Location: Phoenix, AZ

Hours & Schedule: Full-time, Monday through Friday, mornings to 4:00 PM

Work Environment: Neurology Clinic

Salary / Hourly Rate: $20-25 per hour

Why work with us:

This position plays a vital role in ensuring patients receive timely access to medically necessary therapeutic Botox treatments. The role offers a consistent weekday schedule and the opportunity to work closely with clinical teams and insurance payers in a fast-paced, supportive healthcare environment.

What our ideal new team member looks like:

The ideal team member is detail-oriented, highly organized, and experienced in utilization review and prior authorizations. They are comfortable interpreting clinical documentation, navigating payer requirements, and communicating clearly with patients and healthcare staff. They are proactive, collaborative, and committed to supporting quality patient care.

Job Summary:

The Botox Utilization Review Specialist is responsible for obtaining insurance authorization for therapeutic Botox injections, including treatments for migraines, spasms, dystonia, and hyperhidrosis. This role reviews medical records for clinical necessity, verifies benefits, submits authorization requests, and manages denials and appeals. Strong knowledge of insurance processes, medical terminology, and documentation standards is required to ensure timely treatment approval.

Job Duties & Responsibilities:
  • Review medical records to validate diagnoses and supporting documentation
  • Submit prior authorization requests using appropriate ICD-10 and CPT codes
  • Verify medical necessity based on payer-specific clinical criteria
  • Coordinate with insurance carriers to confirm eligibility, benefits, and coverage limitations
  • Track pending, approved, and denied authorizations within the electronic health record
  • Research denied requests and submit appeals with required clinical documentation
  • Communicate authorization status and potential out-of-pocket costs to patients and clinical staff
  • Maintain accurate records while handling confidential information with professionalism
Prerequisites / License & Certification Requirements:
  • High School Diploma or GED
  • Minimum of 3 years of experience in prior authorizations, referrals, or a related medical office role
  • Knowledge of insurance processes and medical terminology
  • Experience using Athena is required
  • Understanding of ICD-10 and CPT coding
  • Strong multitasking and organizational skills
  • Ability to perform efficiently in a high-volume, fast-paced environment
  • Excellent communication, problem-solving, and team collaboration skills

How to Apply

If you're ready to contribute your skills to a respected neurology practice and grow within a supportive environment, please submit your updated resume for confidential consideration. Cover letters and references are encouraged but not required.

Requirements

  • High School Diploma or GED
  • 3+ years of prior authorization experience
  • Athena EHR experience required
  • ICD-10 and CPT coding knowledge
  • Insurance verification experience

Apply