Authorization Coordinator

The Care Coordinator processes patient referral requests to ensure timely and accurate determinations in alignment with utilization management protocols. This role works within a defined scope of practice to complete referrals or forward them to managed care physicians and nurses as appropriate. The Care Coordinator supports providers and patients with referral status questions, maintains required turnaround times, and actively contributes to improving referral processes and workflows within a large, award-winning not-for-profit hospital system.

Responsibilities

• Process patient referrals in accordance with established standard work procedures and utilization management protocols.
• Review each referral with a high level of accuracy and attention to detail to ensure appropriate handling and documentation.
• Monitor daily pending referrals to meet timeliness standards and deliver a high level of customer service to patients and providers.
• Escalate anticipated issues or barriers with referrals to the supervisor and other relevant stakeholders in a timely manner.
• Document updated status and actions taken on referrals in the system according to standard work requirements.
• Provide required medical information and supporting documentation to obtain final determinations from health plans and clinical reviewers.
• Process referrals in compliance with health plan contracts, policies, and requirements, including medical necessity criteria.
• Record final determinations and outcomes in the referral system accurately and consistently as per standard work.
• Assist providers and patients by answering questions regarding referral status and next steps.
• Participate in the development and implementation of improvements to referral processes and workflows to enhance efficiency and service quality.
• Adapt to changes in workload, projects, and priorities, supporting the team during emergencies, staff changes, or technical developments.

• High school diploma or equivalent education and experience.
• Knowledge of medical terminology to accurately interpret and process referrals.
• Working knowledge of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes.
• Knowledge of International Classification of Diseases (ICD-9 and ICD-10) coding.
• Experience with referrals and prior authorization processes in a managed care or health plan environment.
• Understanding of health plan determinations and medical necessity documentation requirements.
• Proficiency with electronic health record (EHR) and electronic medical record (EMR) systems, including EPIC.
• Competency in Microsoft Office applications, particularly Excel and Word.
• Ability to identify, understand, and resolve issues related to claims and referrals.
• Strong communication skills, including the ability to understand medical concepts, organize information, and communicate issues clearly and concisely.
• Ability to quickly adjust to changing projects and priorities and effectively manage multiple tasks.
• Solid organizational skills with the ability to manage time and workload efficiently.

• Experience in utilization review or utilization management within a healthcare or managed care setting.
• Familiarity with managed care programs, policies, and workflows.
• Experience working with health plans, including interpreting plan requirements for referrals and authorizations.
• Background in a large hospital system or similar complex healthcare environment.
• Demonstrated commitment to providing excellent customer service to patients, providers, and internal stakeholders.
• Interest in contributing to process improvement initiatives and workflow optimization.

This position operates in a fully remote setting, working Monday through Friday from 8:00 a.m. to 5:00 p.m. Occasional weekend work may be required based on business needs, though this is rare. The role is part of a large, not-for-profit, award-winning hospital system and involves extensive use of computers, electronic health records (such as EPIC), and standard office software. Work is primarily desk-based, requiring sustained focus on digital systems, accurate data entry, and frequent communication with providers, health plans, and internal teams through phone, email, and electronic messaging.

Job Type & Location

This is a Contract position based out of Sacramento, CA.

The pay range for this position is $24.00 - $24.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on May 15, 2026.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I is embedded into our culture through:

• Hiring diverse talent
• Maintaining an inclusive environment through persistent self-reflection
• Building a culture of care, engagement, and recognition with clear outcomes
• Ensuring growth opportunities for our people

Actalent is an equal opportunity employer.

About Actalent

Actalent is a global leader in engineering and sciences services. For more than 40 years, we’ve helped visionary companies advance their goals. Headquartered in the United States, our teams span 150 offices across North America, EMEA, and APAC—with four delivery centers in India led by 1,000 extraordinary employees who connect their passion with purpose every day.

Our Bangalore, Hyderabad, Pune, and Chennai delivery centers are hubs of engineering expertise, with core capabilities in mechanical and electrical engineering, systems and software, and manufacturing engineering. Our teams deliver work across multiple industries including transportation, consumer and industrial products, and life sciences. We serve more than 4,500 clients, including many Fortune 500 brands. Learn more about how we can work together at actalentservices.com.

Salary : $24