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Prior Authorization Utilization Review Jobs in Missouri

Arch Vista

UR Coordinator

Saint Louis, MO

$15 - $22/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Coordinate and track utilization review and prior authorization requests. * Receive, verify, and organize clinical and administrative documentation required for reviews. * Enter and maintain accurate ...

New

Centene

Supervisor, Utilization Management (RN)

Florissant, MO · On-site +1

$75K - $135K/yr

  • Medical

  • Retirement

  • PTO

Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...

Centene

Supervisor, Utilization Management (RN)

Columbia, MO · On-site +1

$75K - $135K/yr

  • Medical

  • Retirement

  • PTO

Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...

Centene

Supervisor, Utilization Management (RN)

Kansas City, MO · On-site +1

$75K - $135K/yr

  • Medical

  • Retirement

  • PTO

Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...

Centene

Supervisor, Utilization Management (RN)

Columbia, MO · On-site +1

$75K - $135K/yr

  • Medical

  • Retirement

  • PTO

Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...

Centene

Supervisor, Utilization Management (RN)

Saint Louis, MO · On-site +1

$75K - $135K/yr

  • Medical

  • Retirement

  • PTO

Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...

Centene

Supervisor, Utilization Management (RN)

Florissant, MO · On-site +1

$75K - $135K/yr

  • Medical

  • Retirement

  • PTO

Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...

BJC HealthCare

Prior Authorization Rep

Saint Louis, MO · Hybrid

$15.50 - $19.75/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

EPIC, Insurance background, and Prior Authorization experience Overview Preferred Qualifications ... For Ancillary Authorizations, a review of medical records may be required if initiating the ...

Centene

Supervisor, Utilization Management (RN)

Florissant, MO · On-site +1

$75K - $135K/yr

  • Medical

  • Retirement

  • PTO

Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...

Centene

Supervisor, Utilization Management (RN)

Kansas City, MO · On-site +1

$75K - $135K/yr

  • Medical

  • Retirement

  • PTO

Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...

Centene

Supervisor, Utilization Management (RN)

Saint Louis, MO · On-site +1

$75K - $135K/yr

  • Medical

  • Retirement

  • PTO

Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...

Centene

Supervisor, Utilization Management (RN)

Columbia, MO · On-site +1

$75K - $135K/yr

  • Medical

  • Retirement

  • PTO

Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management ...

Diverse Lynx

Pharmacy Technician

Jefferson City, MO · On-site

$18/hr

Process telephonic and written prior authorization requests for medications. * Review medication ... Pharmacy Services, Healthcare Settings, Utilization Review. * Previous customer service experience ...

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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 Missouri?

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

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

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

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

Cities in Missouri 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 Missouri as of August 2026, with employment types broken down into 82% Full Time, and 18% Part Time. Highlights an 100% In-person job distribution.

UR Coordinator

Arch Vista

Saint Louis, MO

$15 - $22/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

New

Job description

UR Coordinator
Pay Range: $15 - $22 hr
Location: St Louis, MO
About Arch Vista
Comprehensive mental health and addiction treatment facility offering 24/7 medical detox, addiction recovery, inpatient psychiatric care, PHP and IOP. Serving adults across Missouri with compassionate, evidence-based treatment in a modern, welcoming environment.

Arch Vista is seeking a detail-oriented and organized Utilization Review (UR) Coordinator to support the utilization management process and ensure timely, accurate coordination of clinical reviews. The UR Coordinator works closely with clinical staff, providers, health plans, and internal departments to facilitate authorization requests, obtain required documentation, track review status, and support efficient patient care.

The ideal candidate has strong communication and organizational skills, understands healthcare workflows, and is comfortable managing multiple time-sensitive requests while maintaining confidentiality and regulatory compliance.

Key Responsibilities
  • Coordinate and track utilization review and prior authorization requests.
  • Receive, verify, and organize clinical and administrative documentation required for reviews.
  • Enter and maintain accurate patient and authorization information in applicable systems.
  • Monitor authorization requests and follow up on outstanding clinical documentation or decisions.
  • Communicate with providers, payers, clinical reviewers, and internal departments regarding review status and requirements.
  • Route cases to appropriate clinical staff for review when clinical determination is required.
  • Assist with obtaining medical records and other supporting documentation.
  • Maintain accurate logs, reports, and documentation related to utilization management activities.
  • Identify missing or incomplete information and work proactively to resolve discrepancies.
  • Support timely completion of reviews in accordance with organizational policies, payer requirements, and applicable regulations.
  • Escalate urgent, complex, or potentially delayed cases to the appropriate team member.
  • Maintain patient confidentiality and comply with HIPAA and organizational privacy policies.
  • Participate in quality improvement initiatives and other departmental projects as assigned.
Qualifications
  • High school diploma or equivalent required; associate degree or healthcare-related education preferred.
  • Must be 21 or older
  • Previous experience in healthcare administration, utilization management, medical records, insurance authorization, care coordination, or a related field preferred.
  • Familiarity with health insurance terminology, prior authorizations, medical records, and clinical documentation preferred.
Preferred Experience
  • Experience in a hospital, health plan, behavioral health, post-acute care, or other healthcare setting.
  • Experience working with payer authorization requirements.
  • Familiarity with utilization management, medical necessity review, or case management workflows.
  • Experience working with electronic medical records and authorization tracking systems.
Why You’ll Love It Here (Full‑Time Benefits)
• Multiple medical plan options, Vista Wellness (physician/pharmacy), Dental, Vision
• Generous PTO and paid holidays
• 401(k) with company contribution; Life and disability coverage
• Tuition reimbursement up to $15,000 and student loan forgiveness programs

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