Utilization Management Coordinator

Job Summary

Supporting Clinical Operations, the full-time remote Utilization Management Coordinator will manage intake, prior authorization, and clinical coordination workflows while ensuring effective communication with members and providers.

Key responsibilities

• Monitor intake queues and manage inbound and outbound correspondence for accurate case entry
• Perform authorization set-up and resolve authorization-related inquiries across multiple case types
• Conduct outbound calls to obtain 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
• Effective communication skills with providers and members