Washington State Utilization Management Coordinator

Job Summary

Responsible for processing Utilization Management (UM) organization determinations, the full-time hourly Washington State Utilization Management Coordinator will perform data entry for authorization requests, validate benefits, and support clinical staff in a remote work environment.

Key responsibilities

• Perform data entry for referrals, prior authorizations, and hospital notifications, including attaching necessary clinical documents
• Research and validate benefit and prior authorization requirements to determine appropriate actions within the Care Management system
• Review and edit denial letters for accuracy, ensuring compliance with deadlines and proper medical terminology

Required qualifications

• Associate degree or equivalent combination of education and relevant experience
• At least one year of customer service experience, preferably in a healthcare setting
• Knowledge of medical terminology and healthcare processes
• Familiarity with Washington Apple Health and Medicare Advantage Plans
• Experience in a Managed Care setting is preferred