prior authorizations specialist.

Our client is seeking a detail-oriented Authorization & Out-of-Network Specialist to join their Utilization Management team. In this role, you will act as a key resource in supporting the prior authorization request process, ensuring all cases are processed accurately and within contractual timelines. You will work closely with out-of-network authorization workflows, assist with member redirection to in-network providers, and support single case agreement (SCA) processes by gathering and routing necessary clinical and contractual details.

salary: $22 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

• Authorization Tracking: Document and track authorization requests and referrals according to established policies and guidelines.
• Out-of-Network & SCA Support: Review out-of-network requests to guide members to in-network providers and submit single case agreement data to contracting teams.
• Clinical Documentation: Gather medical details (history, diagnosis, prognosis) to prepare cases for clinical reviewer determination.
• Eligibility & Benefit Verification: Confirm member coverage and service eligibility to ensure proper alignment for timely payment.
• Data Entry & System Maintenance: Input, update, and manage authorization requests within the utilization management system.
• Provider Outreach: Make occasional calls to healthcare providers to clarify case details while spending most of the day navigating internal systems.
• Compliance: Follow all prior authorization guidelines, maintain policy standards, and stay current on team workflows.

Skills

Utilization Management (2 years of experience is required)

Benefit Verification (2 years of experience is required)

Prior Authorization (2 years of experience is required)

EMR

Basic Software Skills

Written Communication

Qualifications

Years of experience: 2 years

Experience level: Experienced

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At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.