Utilization Review Specialist: Authorizations & Denials

CHS Career Site; United States; On-site; USD 52,000 - 72,000; Full time

Job summary

CHS Career Site is seeking an Utilization Review Coordinator in Franklin, TN. You will manage utilization review processes, collaborate with payers and hospital staff, and secure timely authorizations for admissions and extended stays.

You will monitor and document all authorization activities, assist with process improvements, and serve as a key liaison to reduce denials and optimize patient outcomes.

Qualifications

• Knowledge of utilization management principles, payer requirements, and healthcare regulations.
• Proficiency in case management systems and documentation tools.
• Strong communication and interpersonal skills with payers, clinicians, and staff.
• Critical thinking and problem-solving for authorization and denial issues.
• Excellent organizational skills to manage multiple priorities and deadlines.

Responsibilities

• Submits initial assessments and documentation to establish medical necessity.
• Communicates with payers to secure timely authorizations and reduce denials.
• Monitors and updates case management software with all authorizations and interactions.
• Coordinates Peer-to-Peer discussions for unresolved denials and documents outcomes.
• Closes cases after discharge with complete documentation for billing and audits.
• Maintains KPIs for the Utilization Review Service Line.
• Serves as a liaison to resolve issues with facility and payer representatives.
• Participates in training and onboarding within the department.

Skills

Utilization management

Payer requirements

Communication

Organization

Attention to detail

Training teammates

Education

H.S. Diploma or GED

Bachelor's Degree

Tools

Case management systems

Job description

CHS Career Site is seeking an Utilization Review Coordinator in Franklin, TN. You will manage utilization review processes, collaborate with payers and hospital staff, and secure timely authorizations for admissions and extended stays.

You will monitor and document all authorization activities, assist with process improvements, and serve as a key liaison to reduce denials and optimize patient outcomes.