California Utilization Management Coordinator

Job Summary

Supporting the coordination and administrative functions of the utilization review process, the full-time California Utilization Management Coordinator will manage incoming authorization requests, collaborate with healthcare professionals, and ensure compliance with regulatory guidelines while working remotely.

Key Responsibilities:

• Receive, review, and process incoming requests for authorization of medical services
• Coordinate with providers and internal clinical staff to gather necessary documentation for utilization reviews
• Track and monitor pending authorizations to ensure timely processing and communication of decisions

Required Qualifications:

• High School Diploma or equivalent required; Associate's degree or healthcare certification preferred
• 2+ years of experience in a health plan environment, with a focus on utilization management or case management support preferred
• Capacity to interpret health plan benefit decisions
• Bilingual preferred (English/Spanish)
• Certification as a Medical Assistant preferred