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Prior Authorization Utilization Review Jobs in Oregon

Kairos

Insurance Coordinator

Grants Pass, OR · On-site

Review co-pays, deductibles, coinsurance, visit limits, and authorization requirements * Accurately ... system Authorization & Utilization Management * Obtain and manage prior authorizations for ...

Tricehealthcare

Pharmacy - Pharmacist Inpatient

Portland, OR · On-site

$61.75 - $74.25/hr

... utilization management functions and initiatives including medical drug policy generation, review, and application including prior-authorization, general DUR, and population and group level ...

Acentra Health, LLC

Review Assistant

Portland, OR · On-site

... prior authorization cases. This individual will uphold a comprehensive understanding of internal ... Proficiency in Microsoft Office applications and Excel, ensuring efficient utilization of essential ...

The US Oncology Network

Insurance Reviewer

Eugene, OR

$22 - $32/hr

Overview Insurance Reviewer - Clinical Willamette Valley Cancer Institute is looking for an ... Minimum three (3) years of prior authorization experience required. Revenue cycle 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.

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

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

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

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

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

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

Eligibility & Authorization Coordinator

Consonus Healthcare

Portland, OR • On-site

$19.50 - $24.50/hr

Other

Posted 12 days ago

Job description

Overview
Home Health Eligibility & Authorization Coordinator
Milwaukie, OR
Position Summary
Coordinates insurance verification, payer eligibility review, prior authorizations, and documentation requirements to ensure timely admission and continuation of home health services.
Essential Duties and Responsibilities
Verify insurance eligibility and benefits prior to admission. Obtain and track prior authorizations and recertifications. Review referrals for payer requirements and coverage criteria. Coordinate with referral sources, clinicians, and payers. Maintain authorization logs and expiration dates. Resolve authorization denials and request additional documentation. Support timely intake processing and patient admission. Ensure compliance with CMS, Medicare, Medicaid, and commercial payer requirements. Maintain accurate records in EMR systems. Generate reports related to authorization status and payer trends.
Qualifications
High school diploma required; associate or bachelor degree preferred. Experience in home health intake, insurance verification, authorizations, or healthcare administration preferred.
Knowledge and Skills
Knowledge of Medicare, Medicaid, managed care, EMR systems, payer regulations, communication, organization, and problem-solving skills. Be open to cross-training on the other positions under the intake department.
May other tasks will be asked, added or removed from this job description based on the agency needs.
Performance Expectations
Timely authorization processing, accurate eligibility verification, reduced authorization denials, regulatory compliance, strong customer service, and effective communication.
AgeRight Care at Home provides individualized and comprehensive levels of in-home assistance, with a goal to help keep patients where they want to be for as long as possible. AgeRight Care at Home is part of Marquis Companies and Consonus Healthcare. We are connected as a network of facilities that provide assisted living, long term care, post-acute rehab, as well as rehab and pharmacy services to residents in Oregon, Nevada and California. These connections and resources provide employees of AgeRight the ability grow and pursue a career in healthcare.
EEO Statement
"Be here. Be you."
For more than 30 years, AgeRight has been serving seniors and welcoming staff of all backgrounds, skills, and perspectives. The Marquis family of companies offer a rich heritage of embracing differences and honoring individuality. We've continued to grow in our appreciation of diversity in the workplace. We know it builds strength, drives innovation, and brings valuable new perspectives and energy.
We're committed to making our workforce an even greater reflection of the people and communities we serve, and we are honored our employees have chosen to work at Marquis, Consonus and AgeRight. Everything we do as a company is driven by our mission to help those we serve, and each other, live the best rest of our lives.
That means you being you - without apology or compromise. We value your every uniqueness and continue to curate, nurture, and sustain an inclusive culture. It's the foundation of who we are and the evolution of our collective future.

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