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Utilization Review Assistant Jobs in Edison, NJ (NOW HIRING)

Hurc LLC

Physician Advisor

Short Hills, NJ · On-site

Support utilization review and case management teams with complex clinical decision-making * Ensure ... Support compliance with medical necessity criteria (InterQual, MCG, or equivalent) * Assist with ...

HURC

Physician Advisor

Short Hills, NJ · Remote

Support utilization review and case management teams with complex clinical decision-making * Ensure ... Support compliance with medical necessity criteria (InterQual, MCG, or equivalent) * Assist with ...

Hurc LLC

Physician Advisor

Short Hills, NJ · On-site

Support utilization review and case management teams with complex clinical decision-making * Ensure ... Support compliance with medical necessity criteria (InterQual, MCG, or equivalent) * Assist with ...

Hurc LLC

Physician Advisor

Short Hills, NJ · Remote

Support utilization review and case management teams with complex clinical decision-making * Ensure ... Support compliance with medical necessity criteria (InterQual, MCG, or equivalent) * Assist with ...

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All JobsUtilization Review JobsUtilization Review Assistant JobsUtilization Review Assistant Jobs in Edison, NJ

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 Edison, NJ?

The most popular types of Utilization Review jobs in Edison, NJ are:

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

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Utilization Review Assistant jobs near you

Utilization Review Coordinator - Behavioral Health

Avenues Recovery

Jackson, NJ

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 17 days ago

Job description

Avenues Recovery Center is Now Hiring: Utilization Review Specialists

Avenues Recovery Center is a nationwide network of drug and alcohol rehabilitation centers with eighteen locations across seven states. We provide highly individualized, evidence-based treatment in clean, modern settings across all levels of care including detox, residential, PHP, IOP, and outpatient services.

Our success is driven by our people and a strong clinical model that has helped transform thousands of lives. We are seeking a Utilization Review Specialist to join our corporate team in New Jersey and support authorization, clinical documentation integrity, and continued stay coordination across our network.

Position Overview

Location: Corporate office - New Jersey
Schedule: Full-time

The Utilization Review Specialist ensures timely authorization of client services, supports appropriate level-of-care determinations, and partners closely with clinical and billing teams to maintain accurate documentation and continuity of care across facilities.

This role requires strong communication, attention to detail, and the ability to collaborate across clinical, administrative, and billing departments.

Key ResponsibilitiesUtilization Review & Authorization Management
  • Field incoming calls, emails, and documentation requests related to client authorizations
  • Ensure timely approval and continuation of services at the appropriate level of care
  • Manage client caseloads and support authorization workflows across facilities
  • Advocate for continued stay based on clinical documentation and treatment needs
Clinical & Billing Collaboration
  • Work closely with billing and clinical teams to identify and resolve authorization issues
  • Communicate with facility leadership regarding UR status and documentation needs
  • Support coordination between treatment teams and administrative departments
Documentation & Compliance
  • Maintain accurate electronic records of all UR activity and authorization communications
  • Ensure documentation meets internal standards and payer requirements
  • Assist in identifying gaps in charting and supporting improvements in documentation workflows
Systems & Process Improvement
  • Assist in creating standardized templates and UR workflows across facilities
  • Work with site leaders to ensure consistent implementation of processes
  • Support improvement of internal UR systems and efficiency initiatives
QualificationsRequired / Preferred Education
  • High school diploma or GED required
  • Bachelor's degree preferred
  • Nursing background, clinical background or healthcare knowledge strongly preferred
Experience
  • Minimum 1 year of experience in behavioral health, healthcare, or treatment setting preferred
  • Experience with utilization review, insurance authorization, or medical billing strongly preferred
Core Skills
  • Strong communication (written and verbal)
  • Excellent interpersonal and collaboration skills
  • Strong attention to detail and documentation accuracy
  • Ability to manage multiple cases and deadlines
  • Sound judgment and critical thinking
  • Flexible, team-oriented, and adaptable in a fast-paced environment

Willing to train

Why Join Avenues?

At Avenues, our people are our greatest strength. We foster a culture of support, collaboration, and purpose-driven work, where every team member is valued and empowered to make an impact.

We provide the tools, resources, and benefits needed to help you succeed both personally and professionally.

Comprehensive Benefits
  • 401(k) with employer match
  • Medical, Dental, and Vision Insurance
  • Accident, Critical Illness, and Hospital Indemnity coverage
  • Employer-paid Life and AD&D Insurance
  • Short- and Long-Term Disability options
  • Legal coverage and Identity Theft Protection
  • Pet Insurance
  • Employee Assistance Program (EAP)
  • Flexible Spending Accounts (Medical & Dependent Care)

Join our growing team and discover the magic here at Avenues! Apply today!

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