Utilization Coordinator

JOB DESCRIPTION

Position: Utilization Coordinator 
Department: Operations 
Reports To: Utilization Manager / Director of Operations 
Location: Illinois Branches

ROLE PURPOSE

The Utilization Coordinator is responsible for supporting the daily monitoring and optimization of authorized client service hours across assigned branches. The position focuses on identifying underutilized hours, open shifts, missed visits, scheduling discrepancies, and service gaps and ensuring timely follow-up with Client Coordinators, Schedulers, Branch Managers, and other Operations team members.

The Utilization Coordinator supports the organization in maximizing authorized hours, maintaining continuity of care, reducing lost service hours, and ensuring schedules remain aligned with client authorizations and operational requirements.

KEY RESPONSIBILITIES

1. Daily Utilization Monitoring

• Monitor daily and weekly utilization of authorized service hours for assigned branches.
• Review client schedules to identify underutilized hours and potential service gaps.
• Identify clients who are consistently receiving fewer hours than authorized.
• Follow up with Client Coordinators and Branch teams regarding identified utilization concerns.
• Track the status of identified issues until they are resolved.
• Escalate unresolved utilization concerns to the Utilization Manager or appropriate Operations leadership.
• Monitor cancellations, call-offs, missed visits, and open shifts that may negatively impact utilization.
• Assist with identifying opportunities to recover missed or unused authorized hours when appropriate.

2. Schedule Accuracy Monitoring

• Review schedules to ensure caregiver assignments, service dates, times, and durations are accurate.
• Compare scheduled hours against client authorizations and approved service plans.

• Identify scheduling discrepancies that could result in underutilization, overutilization, or service gaps.
• Communicate identified scheduling issues to the appropriate Client Coordinator, Scheduler, or Branch Manager for correction.
• Follow up to ensure corrections are completed timely.
• Monitor recurring scheduling errors and report trends to the Utilization Manager.
• Verify that schedule changes are properly documented and communicated.
• Assist with monitoring last-minute schedule changes that may affect utilization.

3. Open Shift & Staffing Follow-Up

• Monitor open shifts for assigned branches.
• Follow up with Client Coordinators and Scheduling teams regarding unfilled shifts.
• Track open shifts from identification through resolution.
• Assist with identifying available caregivers who may be appropriate for open cases.
• Monitor recurring staffing gaps and escalate concerns to the Utilization Manager and Branch Leadership.
• Track cancellations and caregiver call-offs that may result in lost authorized hours.
• Follow up on opportunities to reschedule or make up missed hours when permitted.

4. Client Coordinator Support

• Work closely with Client Coordinators to identify and resolve utilization concerns.
• Provide coordinators with information regarding underutilized clients, open shifts, and scheduling discrepancies.
• Follow up on outstanding utilization issues and ensure appropriate action is taken.
• Assist coordinators in understanding utilization expectations and identifying opportunities to improve service-hour delivery.
• Escalate repeated or unresolved utilization concerns to the Utilization Manager.

• Maintain professional and timely communication with branch teams.

5. Reporting & Data Tracking

• Maintain accurate utilization tracking for assigned branches.
• Prepare daily, weekly, and monthly utilization reports as assigned.
• Track authorized hours, scheduled hours, delivered hours, missed hours, and underutilized hours.
• Track open shifts and resolution status.
• Maintain records of identified utilization issues and corrective actions.
• Identify recurring trends and communicate them to the Utilization Manager.
• Assist with preparing utilization information for Operations meetings and leadership reviews.
• Ensure reports are accurate and submitted within established deadlines.

6. Authorization & Compliance Monitoring

• Monitor schedules to ensure services are scheduled within approved authorization limits.
• Identify potential services scheduled outside of authorized hours and escalate them for review.
• Notify the appropriate team when authorization-related concerns may affect service delivery.
• Support compliance with payer, state, and company requirements related to authorized service hours.
• Maintain accurate documentation of utilization-related follow-up.
• Assist with audit preparation by ensuring utilization records are complete and organized.
• Escalate potential compliance concerns immediately to the appropriate Operations or Compliance leadership.

7. Service Gap Monitoring

• Monitor missed visits, cancellations, unfilled shifts, and other events that may create service gaps.

• Follow up with branch teams regarding unresolved service gaps.
• Track whether appropriate replacement staffing or follow-up has occurred.
• Communicate recurring service-gap concerns to the Utilization Manager.
• Work with the appropriate teams to support continuity of client services.

8. Wellness & Client Satisfaction Coordination

• Communicate utilization concerns that are related to client satisfaction or service delivery issues to the appropriate Wellness & Satisfaction team.
• Assist in identifying whether repeated missed hours or staffing issues are contributing to client concerns.
• Follow up on operational actions resulting from utilization-related client concerns.
• Escalate recurring client service issues to the Utilization Manager and appropriate leadership.

9. Process & Performance Support

• Follow established utilization procedures and workflows.
• Identify opportunities to improve daily utilization monitoring and follow-up processes.
• Provide feedback to the Utilization Manager regarding recurring operational challenges.
• Participate in utilization-related training and team meetings.
• Assist with implementation of process improvements established by Operations leadership.
• Maintain current knowledge of company utilization policies, scheduling procedures, and applicable requirements.

KEY PERFORMANCE INDICATORS (KPIs)

1. Utilization Monitoring Accuracy

• Target: ≥ 95% accuracy in daily utilization tracking and reporting.

• Measures the accuracy and reliability of utilization data.

2. Timeliness of Follow-Up

• Target: 100% of identified utilization issues followed up within the established timeframe.
• Measures responsiveness to underutilization, open shifts, and service gaps.

3. Open Shift Follow-Up

• Target: 100% of identified open shifts communicated and tracked through resolution or escalation.
• Measures consistent monitoring and follow-up.

4. Underutilization Follow-Up

• Target: 100% of significant underutilization concerns identified and escalated appropriately.
• Measures the coordinator's ability to identify potential lost authorized hours.

5. Schedule Accuracy

• Target: ≥ 95% accuracy in reviewed schedules.
• Measures alignment between schedules, authorizations, and approved service requirements.

6. Reporting Timeliness

• Target: 100% of assigned utilization reports completed accurately and on time.

7. Authorization Alignment

• Target: 100% identification and escalation of potential services outside approved authorization.

8. Documentation Compliance

• Target: 100% of assigned utilization follow-up properly documented.