ZipRecruiter

Log In

1

Prior Authorization Utilization Review Jobs in Kentucky

UofL Health

RN Utilization Review

Louisville, KY · On-site

... authorization; appropriately documents information regarding the authorization number and the ... utilization review • Knowledgeable of state laws, CMS conditions of participation, and TJC ...

Uoflhealth

RN Utilization Review

Louisville, KY · On-site

... authorization; appropriately documents information regarding the authorization number and the ... to utilization review Knowledgeable of state laws, CMS conditions of participation, and TJC ...

UofL Health

RN Utilization Review

Louisville, KY · On-site

... authorization; appropriately documents information regarding the authorization number and the ... utilization review • Knowledgeable of state laws, CMS conditions of participation, and TJC ...

PharMerica

Prior Authorization Specialist

Louisville, KY · On-site

$16.50 - $22/hr

Tracks and reviews all claims in QuickBase and sends excel tracking spreadsheet to Director of ... prior authorization is being followed up on * Assists Billing Department with resolving unbilled ...

BrightSpring

Prior Authorization Specialist

Louisville, KY

$16.50 - $22/hr

Tracks and reviews all claims in QuickBase and sends excel tracking spreadsheet to Director of ... prior authorization is being followed up on * Assists Billing Department with resolving unbilled ...

PharMerica

Prior Authorization Specialist

Louisville, KY · On-site +1

$16.50 - $22/hr

Tracks and reviews all claims in QuickBase and sends excel tracking spreadsheet to Director of ... prior authorization is being followed up on * Assists Billing Department with resolving unbilled ...

BrightSpring

Prior Authorization Specialist

Louisville, KY

$18.75 - $24.25/hr

Tracks and reviews all claims in QuickBase and sends excel tracking spreadsheet to Director of ... prior authorization is being followed up on * Assists Billing Department with resolving unbilled ...

next page

Showing results 1-20

All JobsPrior Authorization Utilization Review JobsPrior Authorization Utilization Review Jobs in Kentucky

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 Kentucky?

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

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

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

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

Cities in Kentucky 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 Kentucky as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 18% Part Time, 1% Temporary, and 2% Contract. Highlights an 93% Physical, 1% Hybrid, and 6% Remote job distribution.

PRIOR AUTHORIZATION SPECIALIST

Graves Gilbert Clinic

Bowling Green, KY • On-site

$17.50 - $23.25/hr

Other

Re-posted 23 days ago

Graves Gilbert Clinic rating

5.6

Company rating: 5.6 out of 10

Based on 26 frontline employees who took The Breakroom Quiz

Job description

Prior Authorization Specialist

The Prior Authorization Specialist is responsible for verifying patient eligibility and insurance benefits for clinic-administered medications. This position requires a thorough understanding of insurance terminology, benefit structures, and authorization processes to ensure accurate documentation and timely completion of prior authorization requests. The Specialist will obtain, monitor, and maintain authorizations through payer websites, fax, and telephone, including all necessary follow-up and reauthorization activities. This role supports revenue cycle accuracy and contributes to the delivery of high-quality patient care.

Key Responsibilities:

  • Initiate, monitor, and secure prior authorizations from third-party payers.
  • Maintain electronic documentation for all prior authorization activities in accordance with organizational standards.
  • Track pending authorizations and follow up within defined timeframes (7–10 days or payer-specific requirements) to support timely claims submission.
  • Obtain authorization renewals and verify active provider orders and medical necessity documentation.
  • Work collaboratively with clinicians, practice managers, and other team members to obtain clinical notes and documentation necessary for prior authorization approval.
  • Verify authorization quantities and effective dates; ensure accurate processing by third-party payers and correct loading of information in internal systems.
  • Review and confirm patient eligibility, insurance benefits, and plan requirements for clinic-administered medications.
  • Interpret payer pre-certification and authorization guidelines and ensure appropriate approvals are obtained and documented.
  • Input accurate Payer Plan ID numbers and related data into organizational systems to ensure correct billing for current and future services.
  • Determine patient financial responsibility, including coordination of benefits and other coverage considerations.
  • Organize workload and manage deadlines to prevent delays or loss of revenue due to filing limitations.
  • Maintain professional communication with all payers, clinicians, and other team members.
  • Perform additional duties as assigned.

Qualifications:

  • Prior experience in authorization processing and benefit investigation required.
  • Experience with specialty medication authorizations preferred.
  • Strong attention to detail and accuracy.
  • Excellent time management and organizational skills.
  • Proficiency in Microsoft Excel and related software applications.
  • Strong interpersonal and communication skills.
  • Ability to interpret insurance benefits, authorization guidelines, and medical terminology.
  • Ability to work collaboratively in a fast-paced, team-oriented environment.

High School or Equivalent or better. Prior experience in authorization processing and benefit investigation required. Experience with specialty medication authorizations preferred. Ability to interpret insurance benefits, authorization guidelines, and medical terminology.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities 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.

What Graves Gilbert Clinic employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply