Utilization Management Coordinator

A bit about this role: The Utilization Management Coordinator plays a vital role in supporting Clinical Operations by managing the intake, prior authorization, and clinical coordination workflows. This role ensures timely case intake, accurate authorization set-up, and effective coordination with members, providers, and internal clinical teams to support care transitions and authorization processes. The coordinator will be an important part of building strong relationships with health care providers through proactive communication, managing key operational processes to enable efficient, high-quality clinical decisions. This is a fast-paced environment that requires exceptional organization, attention to detail, and a natural talent for customer service. We often require management of several tasks at once, so enthusiasm and organization are key. Utilization Management is a heavily regulated space, so you’ll work through unexpected situations and evolving guidance — including periodic CMS audits where the whole team pitches in on research and root cause. Schedule: This is a full-time, remote position working five 8-hour days per week. Shifts are scheduled between 8:00 AM and 8:00 PM ET, with staggered schedules across the team to ensure seven-day coverage. We are hiring for: Monday – Friday Tuesday – Saturday Sunday – Thursday Your specific start time is assigned within the 8:00 AM – 8:00 PM ET window. We’ll ask about your schedule preference during the process and will do our best to match it. Because we’re filling a limited number of openings on each schedule, availability changes as roles are filled — so we ask that candidates be open to more than one schedule where possible. Your responsibilities and impact will include: Intake Management Monitor intake queues, including daily census validation checks Manage inbound and outbound correspondence Ensure referrals and cases are accurately entered into our system or re-routed to delegates as applicable Prior Authorization Support Perform authorization set-up and case creation in our systems Manage and resolve authorization-related inquiries across multiple case types Review member inpatient status and clinical documentation to support episode updates Ensure required documentation is present for clinical review and determination, including request for information (RFI) work and electronic health record (EHR) access Clinical Coordination & Communication Conduct outbound calls to members and providers to obtain clinical information and communicate UM decisions Schedule and coordinate peer-to-peer (P2P) reviews between providers and Medical Directors Manage Medical Director case assignments and tracking Retrieve medical records via hospital EHR portals and external systems Support the clinical team with case coordination and documentation needs Post-Discharge & Transitional Care Coordination Contact inpatient and post-acute facilities to confirm admission and discharge details Complete daily census checks and assist with discharge planning coordination activities Support care transition workflows and case follow-up Operational & Reporting Support Download and review operational reports (e.g., Looker, Snowflake) Support RFIs and case tracking in inpatient and UM tools Maintain accurate case status and documentation in our system Provide operational and administrative support to the assigned team and manager Required skills and experience: High school diploma or equivalent Experience in healthcare operations, utilization management, care coordination, or prior authorization Proficiency with healthcare systems, EHRs, and reporting tools Effective communication skills with providers and members Strong organizational and multitasking skills in a high-volume environment Attention to detail, follow-through, and time management in a frequently changing environment Desired skills and experience: Prior experience in Medicare Advantage or managed care Intake,