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Prior Authorization Utilization Review Jobs in Colorado

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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?

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.

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.

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.

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 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 job categories do people searching Prior Authorization Utilization Review jobs in Colorado look for? The top searched job categories for Prior Authorization Utilization Review jobs in Colorado are:
What cities in Colorado are hiring for Prior Authorization Utilization Review jobs? Cities in Colorado with the most Prior Authorization Utilization Review job openings:

Utilization Review Coordinator - Behavioral Health Setting

UHS

Highlands Ranch, CO

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 28 days ago


Universal Health Services rating

6.8

Company rating: 6.8 out of 10

Based on 253 frontline employees who took The Breakroom Quiz

493rd of 887 rated healthcare providers


Job description

Responsibilities

This position is required to be onsite! 

Highlands Behavioral Health System is an 86 bed, acute care psychiatric hospital located in Littleton, CO.  Highlands features individual units for adults, and seniors, and offers inpatient acute care, partial hospitalization, and intensive outpatient programs.

Website: https://highlandsbhs.com

The Utilization Review Coordinator possesses knowledge of psychiatric clinical diagnosis and the ability to articulate those indicators professionally. The UM Coordinator manages medical necessity by evaluating the patient medical records to determine severity of patient’s illness and determining the appropriateness of level of care. Serves as liaison for patients and hospital with insurance companies. Negotiates and advocates for patient length of stay and level of care. Oversees utilization review activities with other departments to ensure reimbursement for services provided by the hospital. The UM Coordinator leads physician daily treatment team meetings, manages authorizations and reviews for outpatient programming and at time of admission is responsible for obtaining the precertification. The UM coordinator must be able to work with the business office and admissions departments to complete preliminary verification of benefits. The UM Coordinator has a working knowledge of all levels of care offered and appropriately manages patient benefits.

Benefit & Reward Highlights:

  • Tuition and Educational Reimbursement Program.
  • Student Loan Repayment Program.
  • Challenging and rewarding work environment
  • Career development opportunities
  • Competitive Compensation & Generous Paid Time Off
  • Excellent Medical, Dental, Vision and Prescription Drug Plans
  • Discounts on pet insurance, automotive insurance & homeowners insurance
  • 401(K) with company match and discounted stock plan
  • SoFi Student Loan Refinancing Program

Questions or concerns? Contact the Human Resources department at HIGHLANDSBHSHumanResourceContact@uhsinc.com.

Screening of applications begins immediately and continues until the position is filled.


Qualifications

Requirements:

  • Masters prepared healthcare professional (Counseling, Psychology, or Social Work) required or RN with direct experience.
  • Valid RN license, LCSW, or LPC preferred.
  • A minimum of 3-5 years direct psychiatric patient care experience.
  • Must possess knowledge of psychiatric care, utilization review, insurance reimbursement procedures, DSM-V, etc. Advanced computer skills necessary. Strong analytical, organizational, verbal and written skills required.

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500® corporation, annual revenues during 2025 were $17.4 billion. In 2026, UHS was again recognized as one of Fortune World’s Most Admired Companies™ and in 2025, was listed in Forbes ranking of America’s Largest Public Companies.

Headquartered in King of Prussia, PA, UHS has approximately 101,500 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 40 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. For additional information visit www.uhs.com.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

Avoid and Report Recruitment Scams

We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information.

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

Qualifications:

Requirements:

  • Masters prepared healthcare professional (Counseling, Psychology, or Social Work) required or RN with direct experience.
  • Valid RN license, LCSW, or LPC preferred.
  • A minimum of 3-5 years direct psychiatric patient care experience.
  • Must possess knowledge of psychiatric care, utilization review, insurance reimbursement procedures, DSM-V, etc. Advanced computer skills necessary. Strong analytical, organizational, verbal and written skills required.

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500® corporation, annual revenues during 2025 were $17.4 billion. In 2026, UHS was again recognized as one of Fortune World’s Most Admired Companies™ and in 2025, was listed in Forbes ranking of America’s Largest Public Companies.

Headquartered in King of Prussia, PA, UHS has approximately 101,500 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 40 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. For additional information visit www.uhs.com.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

Avoid and Report Recruitment Scams

We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information.

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

Education:UNAVAILABLEEmployment Type: FULL_TIME

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About Universal Health Services

Sourced by ZipRecruiter

Universal Health Services (UHS) is a major player in the healthcare industry, based in King of Prussia, Pennsylvania, U.S. Founded in 1978, UHS offers hospital and healthcare services. Their diverse services range from acute care hospitals, behavioral health facilities and ambulatory centers nationwide. The company's mission of enhancing the health and well-being of their patients is reflected in their commitment to 'Helping Individuals Live Longer, Healthier and Happier Lives'. Universal Health Services' consistent growth and success in their industry have been recognized on numerous occasions, including being ranked amongst the Fortune 500 list of largest companies.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

King of Prussia, PA, US