Utilization Review (UR) Solutions Analyst
Hurc
Short Hills, NJ$80,000 - $85,000 a yearFull Time
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Job Description
The Utilization Review (UR) Solutions Analyst supports the effectiveness and scalability of the utilization review function through data analysis, systems optimization, and process improvement. This role translates clinical and operational needs into practical solutions that improve authorization outcomes, reduce denials, and ensure compliance with payer and regulatory requirements.
The UR Solutions Analyst works cross-functionally with UR Clinical and Operations leadership, Revenue Cycle, Compliance, and IT to enhance workflows, reporting, and technology that support utilization management activities.
Key Responsibilities
Data Analysis & Reporting
Develop, maintain, and analyze UR metrics including authorization turnaround times, denial rates, appeal outcomes, and payer trends
Create dashboards and reports to support operational and clinical decision-making
Identify trends, gaps, and opportunities for improvement across payers and services
Systems & Technology Support
Serve as a subject matter expert for UR-related systems, payer portals, and authorization tools
Partner with IT and vendors to optimize system configurations, workflows, and integrations
Support implementation and optimization of UR platforms, criteria tools (e.g., InterQual, MCG), and payer connectivity
Process Improvement & Solutions Design
Analyze end-to-end UR workflows to identify inefficiencies, risks, or compliance gaps
Design and implement solutions to improve timeliness, accuracy, and consistency
Standardize workflows and documentation practices across UR teams
Denials & Authorization Optimization
Support root-cause analysis of denials and authorization delays
Collaborate with UR leadership and Revenue Cycle on corrective action plans
Track effectiveness of interventions and process changes over time
Compliance & Audit Support
Support internal and external audits by providing data, documentation, and analysis
Ensure reporting and processes align with regulatory, accreditation, and payer requirements
Assist in maintaining UR-related policies, procedures, and documentation
Cross-Functional Collaboration
Act as a liaison between UR, Operations, Clinical teams, Revenue Cycle, Compliance, and IT
Translate clinical and operational requirements into technical or analytical solutions
Support training initiatives related to systems, data, and workflow changes
Qualifications
Required
Bachelor’s degree in Healthcare Administration, Health Informatics, Business Analytics, or related field (or equivalent experience)
Minimum of 3–5 years of experience in utilization review, healthcare analytics, revenue cycle, or healthcare operations
Strong understanding of utilization management workflows and payer authorization processes
Experience with healthcare data reporting, dashboards, and analytics tools
Advanced Excel skills and experience with reporting platforms
Preferred
Experience supporting denials management and appeals
Familiarity with EHR systems and payer portal integrations
Experience in behavioral health or specialty care utilization review
Skills & Competencies
Responsive and client focused
Be an effective liaison between client, stakeholders and vendor teams.
Analytical and solutions-oriented mindset
Strong problem-solving and process-mapping skills
Ability to translate complex data into actionable insights
Excellent communication and stakeholder-management skills
Detail-oriented with a strong focus on accuracy and compliance
HURC Healthcare is an Equal Opportunity Employer. We are committed to creating a diverse and inclusive workplace and do not discriminate on the basis of race, color, religion, sex, pregnancy, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by federal, state, or local law.
The UR Solutions Analyst works cross-functionally with UR Clinical and Operations leadership, Revenue Cycle, Compliance, and IT to enhance workflows, reporting, and technology that support utilization management activities.
Key Responsibilities
Data Analysis & Reporting
Develop, maintain, and analyze UR metrics including authorization turnaround times, denial rates, appeal outcomes, and payer trends
Create dashboards and reports to support operational and clinical decision-making
Identify trends, gaps, and opportunities for improvement across payers and services
Systems & Technology Support
Serve as a subject matter expert for UR-related systems, payer portals, and authorization tools
Partner with IT and vendors to optimize system configurations, workflows, and integrations
Support implementation and optimization of UR platforms, criteria tools (e.g., InterQual, MCG), and payer connectivity
Process Improvement & Solutions Design
Analyze end-to-end UR workflows to identify inefficiencies, risks, or compliance gaps
Design and implement solutions to improve timeliness, accuracy, and consistency
Standardize workflows and documentation practices across UR teams
Denials & Authorization Optimization
Support root-cause analysis of denials and authorization delays
Collaborate with UR leadership and Revenue Cycle on corrective action plans
Track effectiveness of interventions and process changes over time
Compliance & Audit Support
Support internal and external audits by providing data, documentation, and analysis
Ensure reporting and processes align with regulatory, accreditation, and payer requirements
Assist in maintaining UR-related policies, procedures, and documentation
Cross-Functional Collaboration
Act as a liaison between UR, Operations, Clinical teams, Revenue Cycle, Compliance, and IT
Translate clinical and operational requirements into technical or analytical solutions
Support training initiatives related to systems, data, and workflow changes
Qualifications
Required
Bachelor’s degree in Healthcare Administration, Health Informatics, Business Analytics, or related field (or equivalent experience)
Minimum of 3–5 years of experience in utilization review, healthcare analytics, revenue cycle, or healthcare operations
Strong understanding of utilization management workflows and payer authorization processes
Experience with healthcare data reporting, dashboards, and analytics tools
Advanced Excel skills and experience with reporting platforms
Preferred
Experience supporting denials management and appeals
Familiarity with EHR systems and payer portal integrations
Experience in behavioral health or specialty care utilization review
Skills & Competencies
Responsive and client focused
Be an effective liaison between client, stakeholders and vendor teams.
Analytical and solutions-oriented mindset
Strong problem-solving and process-mapping skills
Ability to translate complex data into actionable insights
Excellent communication and stakeholder-management skills
Detail-oriented with a strong focus on accuracy and compliance
HURC Healthcare is an Equal Opportunity Employer. We are committed to creating a diverse and inclusive workplace and do not discriminate on the basis of race, color, religion, sex, pregnancy, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by federal, state, or local law.