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Prior Authorization Utilization Review Jobs in Georgia

Curant Health

Prior Authorization Specialist

Smyrna, GA · On-site

$18 - $24/hr

The Prior Authorization specialist responsibilities includes: taking in-bound calls from providers ... For further information, please review the Know Your Rights notice from the Department of Labor.

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA

The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will ... Authorizing entities to ensure initial precertification and continued authorization is achieved

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will ... Authorizing entities to ensure initial precertification and continued authorization is achieved

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will ... Authorizing entities to ensure initial precertification and continued authorization is achieved

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will ... Authorizing entities to ensure initial precertification and continued authorization is achieved

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will ... Authorizing entities to ensure initial precertification and continued authorization is achieved

UHS

Utilization Review Nurse (RN)

Augusta, GA · On-site

... authorization is achieved * Utilization Review/Business Office Coordinator will ensure input of pre-certifications and continued stay reviews into Midas * Follow-up on unfinished pre-certifications ...

UHS

Utilization Review Nurse (RN)

Augusta, GA · On-site

... authorization is achieved * Utilization Review/Business Office Coordinator will ensure input of pre-certifications and continued stay reviews into Midas * Follow-up on unfinished pre-certifications ...

UHS

Utilization Review Nurse (RN)

Augusta, GA · On-site

... authorization is achieved * Utilization Review/Business Office Coordinator will ensure input of pre-certifications and continued stay reviews into Midas * Follow-up on unfinished pre-certifications ...

UHS

Utilization Review Nurse (RN)

Augusta, GA · On-site

... authorization is achieved * Utilization Review/Business Office Coordinator will ensure input of pre-certifications and continued stay reviews into Midas * Follow-up on unfinished pre-certifications ...

UHS

Utilization Review Nurse (RN)

Augusta, GA · On-site

... authorization is achieved * Utilization Review/Business Office Coordinator will ensure input of pre-certifications and continued stay reviews into Midas * Follow-up on unfinished pre-certifications ...

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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 Georgia?

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

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

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

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

Cities in Georgia 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 Georgia as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 18% Part Time, 1% Temporary, and 3% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution.

Prior Authorization Specialist

Curant Health

Smyrna, GA • On-site

$18 - $24/hr

Full-time

Medical, PTO

Re-posted 5 hours ago

Job description

JOIN A LEADING HEALTHCARE COMPANY
At Curant Health, our vision is Personalize healthcare driven by choice and defined by value. As a Curant Health employee, your role is to deliver on that vision every day by delivering excellent Customer Service, Personalize Care, Accountability, Innovation, and Integrity. You take initiative, set goals, and solve problems while collaborating with friends and colleagues. Together we make a meaningful impact on our patients lives.
In return, Curant Health is committed to providing you competitive pay, excellent benefits, and an opportunity to make a difference each day as we strive to reach our vision to be the preferred health care partner by excelling in quality, service, and affordability.
Curant Health, the leader in patient-centric chronic disease management via specialty pharmacy is searching for an Prior Authorization Specialist to join its team in Smyrna, GA. We are committed to improving patient health outcomes by offering a pharmacist-managed medication care program, comprehensive therapeutic monitoring and dependable home delivery of prescription drugs.
The Prior Authorization specialist responsibilities includes: taking in-bound calls from providers, PBM, etc. providing phone assistance to all callers through the prior authorization process.
Responsibilities
  • Maintaining complete, timely and accurate documentation of all approvals and denials, and transferring all clinical questions and judgment calls to the pharmacist.
  • Assist physician groups in initiating prior authorization, follow up with PBM, and initiate appeals if applicable.
  • Assist with other duties such as outbound calls, monitoring/responding to inquiries and other duties as assigned by the Patient Services manager.
  • Manages work volume from inception to delivery utilizes appropriate courteous and professional behavior based upon established standards
  • Complies with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.
  • Manage written or formal documentation to patients and provider on prior authorization status.
  • Communicates with Patient Care Coordinators and other internal teams for timely resolution of appeals/exceptions.
  • General administrative support as assigned by manager.
  • Provide backup support to team members as needed.
Qualifications
  • Requires a high school diploma or equivalent
  • 1 year experience
  • Registered Pharmacy Technician

Why Work for Us?
We offer competitive pay, paid holidays, benefits, paid time off and a work/life balance. Not only that, but we also offer paid parental leave, recognition programs, promotion opportunities, a comprehensive training program to enhance your career, and employee prescription discounts.
Our Core Values consist of ICARE; Integrity, Communication, Accountability, Relationships and Excellence, and we take pride in you embodying those traits. Curant Health is an equal opportunity employer.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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