Utilization Review Specialist: Authorizations & Denials

Community Health Systems, Inc.; Franklin (TN); On-site; USD 52,000 - 76,000; Full time

Job summary

Community Health Systems, Inc. in Franklin, TN seeks an Utilization Review Coordinator to manage authorizations for hospital admissions and extended stays, coordinating with payers, hospital staff, and clinicians to secure timely authorizations and ensure medical necessity.

You will document all actions in case management systems, support process improvements, and strive to reduce denials while maintaining compliance and high-quality patient care.

Qualifications

• Knowledge of utilization management principles, payer requirements, and healthcare regulations.
• Experience with case management systems or authorization tracking software.
• Strong communication with payers, clinicians, and administrative staff.
• Attention to detail and ability to document accurately.

Responsibilities

• Submit initial assessments and stay reviews with required documentation to establish medical necessity.
• Coordinate with commercial payers to secure timely authorizations and reduce denials.
• Update case management software with authorization details, denials, and payor interactions.
• Coordinate Peer-to-Peer discussions for unresolved denials and document outcomes.

Skills

Utilization management

Payer communication

Documentation

Analytical thinking

Organization

Education

High School Diploma or GED

Bachelor's Degree preferred

Job description

Community Health Systems, Inc. in Franklin, TN seeks an Utilization Review Coordinator to manage authorizations for hospital admissions and extended stays, coordinating with payers, hospital staff, and clinicians to secure timely authorizations and ensure medical necessity.

You will document all actions in case management systems, support process improvements, and strive to reduce denials while maintaining compliance and high-quality patient care.