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Utilization Review Assistant Jobs in Texas (NOW HIRING)

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Utilization Review Assistant information

What is a utilization review assistant?

A Utilization Review Assistant supports the utilization review process by reviewing medical records, verifying insurance coverage, and ensuring that healthcare services meet necessary guidelines. They assist in gathering documentation, communicating with insurance providers, and coordinating with medical staff to facilitate approvals for treatments. Their role helps ensure that healthcare services are provided efficiently while maintaining compliance with insurance policies and regulations.

What does a utilization review assistant do?

A Utilization Review Assistant typically spends their day reviewing medical records, verifying patient information, and ensuring documentation meets insurance or regulatory requirements. They often work closely with nurses, physicians, case managers, and billing staff to collect necessary data and clarify documentation. The work is usually performed in an office within a hospital, clinic, or insurance company, where prioritizing tasks and maintaining confidentiality are key. This collaborative, detail-oriented environment provides a valuable introduction to healthcare administration and can open doors to broader roles in utilization management or case management.

What skills and qualifications are needed to be a utilization review assistant?

To thrive as a Utilization Review Assistant, you need attention to detail, basic understanding of medical terminology, strong organizational skills, and typically a high school diploma or equivalent. Familiarity with healthcare management software and electronic health records (EHR) systems, along with experience in data entry, is important for this role. Strong communication, problem-solving abilities, and a customer service-oriented attitude help you excel when interacting with clinical staff and patients. These skills are essential for ensuring accurate review processes, compliance with regulations, and effective coordination within healthcare teams.

How do I get into a utilization review assistant?

To become a utilization review assistant, candidates typically need a high school diploma or equivalent, with some roles preferring healthcare-related certifications or experience. Strong organizational skills, attention to detail, and familiarity with medical records and insurance processes are important; some positions may require knowledge of healthcare management software. Gaining relevant experience or certifications can improve job prospects in this field.

What are the most commonly searched types of Utilization Review jobs in Texas?

The most popular types of Utilization Review jobs in Texas are:

What are popular job titles related to Utilization Review Assistant jobs in Texas?

For Utilization Review Assistant jobs in Texas, the most frequently searched job titles are:

What job categories do people searching Utilization Review Assistant jobs in Texas look for?

The top searched job categories for Utilization Review Assistant jobs in Texas are:

What cities in Texas are hiring for Utilization Review Assistant jobs?

Cities in Texas with the most Utilization Review Assistant job openings:

Utilization Review Assistant jobs near you
Infographic showing various Utilization Review Assistant job openings in Texas as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution.

Clinical Review Specialist (31389)

GI Alliance

Southlake, TX • On-site

$65K - $90K/yr

Full-time

Re-posted 23 days ago

Key responsibilities

  • Provides clinical oversight and review to ensure the completeness and accuracy of prior approvals based on payer requirements on all assigned patients and locations.

  • Collaborates with practice staff, physicians, patients, payers, and infusion department to obtain needed information and complete job tasks and responsibilities.

  • Completes Letters of Medical Necessity or other required clinical documents to assist with the intake and appeal process.

GI Alliance rating

6.4

Company rating: 6.4 out of 10

Based on 69 frontline employees who took The Breakroom Quiz

648th of 898 rated healthcare providers

Job description

GI Alliance is seeking an experienced Clinical Review Specialist.
Duties of this position include, but are not limited to, the following:
Position purpose
Works collaboratively with multiple stakeholders in Infusion Operations to ensure required clinical information is received and reviewed in the infusion intake workflow based on payer and regulatory requirements and lead and manage the appeal process as required.
Responsibilities/Duties/Functions/Tasks:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Provides clinical oversight and review to ensure the completeness and accuracy of prior approvals based on payer requirements is achieved on all assigned patients and locations.
  • Attention to detail regarding required documentation and follow up with outstanding information on a timely basis
  • Collaborates with practice staff, physicians, patients, payers and infusion department in obtaining needed information to complete job tasks and responsibilities
  • Consistently identifies and tracks information on referrals/ appeals as needed
  • Documents all necessary information in appropriate electronic tools, communicates with appropriate stakeholders timely and coordinates peer to peer communication as per recommended timelines.
  • Completes Letters of Medical Necessity or other required clinical documents to assist with the intake and appeal process
  • Completes all reviews within department established policies and best practice standards.
  • Prioritizes incoming work appropriately and timely and communicates to all required stakeholders as appropriate at each step of the workflow
  • Serve as a clinical resource to non-clinical staff
  • Assist with quality audits and maintain accurate reports.
  • Actively participates in the department's performance improvement initiatives
  • Perform other duties as assigned

EDUCATION: Nursing Degree or diploma from an accredited institution required. LVN or RN in good standing required.
EXPERIENCE: Minimum of five (5) years of relevant nursing experience. Minimum one (1) year of case management and/ or utilization review in acute care or insurance related role.
Other Qualifications: Infusion experience preferred.
Performance Requirements:
  • Knowledge of clinic policies and procedures.
  • Knowledge of medical terminology and insurance practices.
  • Knowledge of computer programs and applications.
  • Knowledge of CPT and ICD-10 coding.
  • Knowledge of managed care, Medicare, and Medicaid guidelines.
  • Skill in written and verbal communication.
  • Ability to work effectively as a team member with physicians and other staff.
  • Ability to flexibly respond to changing demands.
  • Ability to plan, organize, prioritize and complete work independently
  • Ability to sort and file materials correctly by alphabetic or numeric systems.
  • Ability to establish and maintain effective working relationships with patients, employees, and the public.
  • Prior experience with clinical review, case management, utilization review
  • Experience managing patient issues professionally.

Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.
Work Environment: Work requires hand dexterity for office machine operation, stooping and bending to files and supplies, mobility to complete errands, or sitting for extended periods of time. Occasionally lifting files or paper weighing up to 20 pounds. Occasionally work environment may be very stressful.
Mental/Physical Requirements: Normal office environment. May view computer screens for long periods of time. Occasional evening or weekend work.
GI Alliance is an Equal Opportunity Employer. We are committed to creating an inclusive, welcoming, and equitable work environment. Our company values and celebrates the diversity of our physicians, staff and patients. We firmly believe our service is greatly enriched by our diversity of thought, experience, perspective, culture, and background.
Please Note: All job offers are contingent on the successful completion of pre-employment criminal history check.
NOTE: ALL APPLICATIONS MUST BE COMPLETED IN FULL FOR CONSIDERATION.
No phone calls or agencies, please.
EEO/AA-M/F/disabled/protected veteran

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