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Prior Authorization Utilization Review Jobs in Ohio

TriHealth

Prior Authorization Specialist

Cincinnati, OH ยท On-site

$17.25 - $23/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Review medical record to obtain necessary patient demographic and clinical information and seek timely clarification from pharmacist or physician as necessary * Review Prior Authorization denials and ...

Nationwide Children's Hospital

Performs pre-certifications, pre-authorizations, re-authorization, concurrent utilization reviews, retrospective reviews, and denial management. Interacts with staff and departments of the hospital ...

Sevita

Utilization Review Specialist

Akron, OH ยท On-site

$40K/yr

SUMMARY The Utilization Review Specialist is responsible for proactive planning measures, accurate ... Provides professional oversight of service delivery authorizations and assurances, effective ...

Midwest Vision Partners

Prior Authorization Specialist

Stow, OH ยท On-site

$16.50 - $22/hr

  • Medical

  • Dental

  • Life

  • Retirement

  • PTO

Review insurance requirements to determine if prior authorization is required. * Utilizes resources to identify any testing that may require prior authorization. * Review chart documentation to ...

Equitas Health

Prior Authorization Specialist

Columbus, OH ยท On-site

$18.13 - $21.78/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Prior Authorization Specialist Established in 1984, Equitas Health is a regional not-for-profit ... For further information, please review the Know Your Rights notice from the Department of Labor.

Riverhills Neuroscience

Prior Authorization Specialist

Norwood, OH ยท On-site

$18 - $22/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Prior Authorization Specialist For over two decades, Riverhills Neuroscience has been a pioneer in ... Coordinate with insurance entities, review organizations, and clinical contacts for effective ...

Lifepoint Health

Specialist, Utilization Review

Columbus, OH ยท On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Professional development and growth opportunities How you'll contribute Utilization Review ... Reports appropriate denial, and authorization information to designated resource. Actively ...

TriHealth, Inc.

Prior Authorization Specialist

Montgomery, OH

$17.25 - $23/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

The prior authorization specialist is responsible for coordinating all aspects of the prior authorization process, including insurance verification, formulary reviews, gathering necessary clinical ...

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All JobsPrior Authorization Utilization Review JobsPrior Authorization Utilization Review Jobs in Ohio

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 are popular job titles related to Prior Authorization Utilization Review jobs in Ohio?

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

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

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

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

Cities in Ohio 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 Ohio as of August 2026, with employment types broken down into 86% Full Time, and 14% Part Time. Highlights an 100% In-person job distribution.