Healthcare Utilization & Authorization Specialist

ST VINCENT FAMILY SERVICES; Columbus (OH); Hybrid; USD 55,000 - 75,000; Full time

Job summary

St. Vincent Family Services in Columbus, OH is seeking an Utilization Management Specialist to coordinate prior authorizations for clinical services across multiple MCOs.

You will serve as the main liaison between the agency and payors, ensuring timely submissions, accurate tracking, and uninterrupted care for clients. Responsibilities include monitoring eligibility, tracking units, renewals, and communicating approvals/denials to treatment teams, while maintaining robust records and supporting

Qualifications

• Experience in healthcare authorization management or utilization management.
• Knowledge of Medicaid and Managed Care authorization procedures.
• Strong organizational skills and attention to detail.
• Strong analytical skills and ability to interpret utilization reports.
• Ability to manage multiple deadlines and priorities.
• Ability to communicate effectively with clinical, administrative, and payer representatives.
• Ability to maintain accurate records and follow complex payer requirements.

Responsibilities

• Coordinate and manage all prior authorization activities for clinical services across multiple Medicaid Managed Care Organizations (MCOs).
• Serve as the primary liaison between St. Vincent Family Services and MCO payors to ensure timely submissions.
• Monitor client eligibility, track authorized units, renewals, and communicate approvals/denials to treatment teams.
• Maintain an authorization tracking system with numbers, dates, codes, units, remaining units, and expirations.
• Collaborate with program leadership, billing, and MCO representatives to maximize reimbursement and ensure continuity of care.
• Maintain organized electronic records of all submissions and determinations.
• Assist with audits, quality assurance activities, and compliance reviews related to authorization management.

Skills

Behavioral health authorization

Payer requirements

Organizational skills

Analytical skills

Communication skills

Record keeping

Independent work

Education

Associate's Degree

Bachelor's Degree preferred

Tools

Microsoft Outlook

Excel

Word

Teams

MCO portals

Electronic health records

Job description

St. Vincent Family Services in Columbus, OH is seeking an Utilization Management Specialist to coordinate prior authorizations for clinical services across multiple MCOs.

You will serve as the main liaison between the agency and payors, ensuring timely submissions, accurate tracking, and uninterrupted care for clients. Responsibilities include monitoring eligibility, tracking units, renewals, and communicating approvals/denials to treatment teams, while maintaining robust records and supporting