Utilization Management Coordinator

Job Summary

Supporting Clinical Operations in a full-time remote capacity, the Utilization Management Coordinator will manage intake, prior authorization, and clinical coordination workflows to ensure timely case processing and effective communication with members and providers.

Key responsibilities

• Monitor intake queues and manage inbound/outbound correspondence to ensure accurate case entry
• Perform authorization set-up and manage authorization-related inquiries while ensuring required documentation is present for clinical review
• Conduct outbound calls to members and providers for clinical information and coordinate peer-to-peer reviews

Required qualifications

• High school diploma or equivalent
• Experience in healthcare operations, utilization management, care coordination, or prior authorization
• Proficiency with healthcare systems, EHRs, and reporting tools
• Strong organizational and multitasking skills in a high-volume environment
• Attention to detail and time management in a frequently changing environment