Utilization Management Coordinator

Job Overview
We are seeking a detail-oriented and highly organized Utilization Coordinator to join our team. This role is essential in ensuring that services are delivered efficiently, cost-effectively, and in alignment with organizational, regulatory, and payer requirements. The ideal candidate is skilled in clinical documentation review, workflow coordination, and communication with internal teams and external partners.

Responsibilities

• Review service authorizations, referrals, and clinical documentation for accuracy, completeness, and appropriateness.
• Coordinate utilization review processes, including tracking requests, monitoring timelines, and ensuring compliance with payer and regulatory guidelines.
• Serve as a liaison between providers, payers, and internal departments to facilitate timely approvals and service delivery.
• Maintain up-to-date knowledge of insurance requirements, medical necessity criteria, and organizational policies.
• Support development and maintenance of utilization management workflows, including reporting and data tracking.
• Document all utilization-related activities in the electronic recordkeeping systems with accuracy and timeliness.
• Identify potential barriers to service authorization and escalate issues as needed.
• Assist with audits, quality assurance activities, and performance improvement initiatives.
• Provide education to staff on utilization procedures and documentation standards.

Skills

• High attention to detail and strong time-management abilities.
• Ability to work independently and manage competing priorities.
• Strong interpersonal skills for effective collaboration with multidisciplinary teams.
• Problem-solving mindset with the ability to navigate complex authorization processes.
• Strong communication skills for training staff and collaborating across multidisciplinary teams. This position offers an opportunity to impact healthcare quality through effective management of clinical documentation while supporting compliance with industry standards in a dynamic healthcare environment.

Qualifications

• Experience working with Medicaid/Medicare and commercial insurance plans
• Familiarity with accreditation requirements (e.g., NCCHC, ACA, Joint Commission).

Job Type: Full-time

Pay: $30.00 - $35.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Travel reimbursement
• Vision insurance

Work Location: In person

Salary : $30 - $35