Healthcare Utilization & Authorization Specialist

Socket.dev; Southaven (MS); On-site; USD 65,000 - 95,000; Full time

Benefits offered by this job

Medical Coverage

Student Loan Repayment

Retirement Benefits

PTO / Paid Time Off

Voluntary Benefits

Job summary

Bradford Health Services in the United States seeks a dedicated Utilization Review Specialist to ensure medical necessity, efficiency and regulatory compliance across patient care reviews. You’ll evaluate records, treatment plans, and data while collaborating with physicians, insurers, and case managers to secure timely approvals.

This role emphasizes clinical knowledge, regulatory guidelines, and strong analytical skills to optimize outcomes and manage costs.

Qualifications

• Bachelor’s degree in a healthcare or related field.
• At least 2 years of utilization review, case management, or clinical roles.
• Strong knowledge of medical terminology and healthcare regulations.
• Familiarity with insurance authorization processes and reimbursement models.
• Excellent analytical, communication, and organizational skills.

Responsibilities

• Review medical records and treatment plans to assess necessity and appropriateness.
• Coordinate with providers, insurers, and case managers to gather details.
• Decide on authorization, continuation, modification, or denial of services per guidelines.
• Maintain accurate records of utilization review activities and communications.
• Stay current with healthcare regulations and payer policies to ensure compliant reviews.

Skills

Clinical analysis

Regulatory knowledge

Medical terminology

Analytical thinking

Communication

Organizational skills

Education

Bachelor’s degree in healthcare or related field

Tools

EHR systems

Utilization management software

Job description

Bradford Health Services in the United States seeks a dedicated Utilization Review Specialist to ensure medical necessity, efficiency and regulatory compliance across patient care reviews. You’ll evaluate records, treatment plans, and data while collaborating with physicians, insurers, and case managers to secure timely approvals.

This role emphasizes clinical knowledge, regulatory guidelines, and strong analytical skills to optimize outcomes and manage costs.