What Does a Utilization Management Support Coordinator Do?
A Utilization Management (UM) Support Coordinator plays a crucial role in helping healthcare organizations ensure that patients receive appropriate care while adhering to regulatory and payer requirements. They provide administrative and clerical support to utilization management teams, assisting with the coordination of pre-authorizations, medical necessity reviews, and documentation workflows.
These professionals do not make clinical decisions, but are essential in facilitating them. They track pending reviews, gather patient records, follow up with providers and payers, and input utilization data into internal systems. Their work helps streamline communication among medical staff, insurance companies, and patients, ultimately supporting the delivery of cost-effective and timely care.
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Utilization Management Support Coordinator Core Responsibilities
- Provide administrative support to utilization management nurses and case managers
- Process prior authorizations and enter data into UM software or EHR systems
- Schedule peer reviews and communicate with providers on documentation needs
- Review incoming requests for completeness and compliance
- Ensure timelines for reviews, authorizations, and appeal processes are met
- Assist with generating reports for audits and regulatory bodies
- Coordinate with claims, billing, and clinical teams for case follow-up
- Maintain confidentiality of sensitive medical and patient information
- Respond to inquiries from internal departments and external providers
- Support compliance with health plan, CMS, and NCQA guidelines
Required Skills and Qualifications
Hard skills
- Proficiency in electronic health record (EHR) and UM platforms (e.g., Epic, Cerner, MCG)
- Familiarity with medical terminology and healthcare documentation standards
- Understanding of prior authorization and medical necessity review workflows
- Strong data entry, reporting, and recordkeeping skills
- Knowledge of HIPAA and healthcare privacy regulations
Soft skills
- Excellent organizational and time management skills
- Strong attention to detail and accuracy
- Clear verbal and written communication skills
- Ability to multitask in a fast-paced, deadline-driven environment
- Professionalism in interacting with healthcare professionals and insurers
Educational requirements
- High school diploma or GED required
- Associate degree or coursework in healthcare administration, medical billing, or a related field preferred
Certifications
Certification in medical terminology, healthcare compliance, or coding (e.g., CPC, CCA) is helpful but not typically required
Preferred Qualifications
- Experience working in a managed care or health insurance environment
- Background in pre-certification, referrals, or case review support
- Familiarity with CMS, NCQA, or URAC utilization management standards
- Exposure to appeals, grievances, or denial management processes
- Bilingual skills may be an asset in diverse patient populations
National Average Salary
Utilization management support coordinator salaries vary by experience, industry, organization size, and geography. Click below to explore salaries by local market.
The average national salary for an Utilization Management Support Coordinator is:
$65,955
Sample Utilization Management Support Coordinator Job Descriptions
When it comes to recruiting a utilization management support coordinator, having the right job description can make a big difference. Here are some real-world job descriptions you can use as templates for your next opening.
Example 1: Medical Authorization Coordinator
Position overview
The Medical Authorization Coordinator supports the Utilization Management (UM) department by managing pre-authorization workflows for medical procedures, medications, and outpatient services. This role ensures timely, accurate processing of requests and fosters coordination between healthcare providers, payers, and UM clinicians.
Responsibilities
- Process incoming prior authorization and referral requests
- Validate eligibility and documentation against payer requirements
- Track pending authorizations and escalate delays as needed
- Maintain accurate records in the UM platform and EHR
- Liaise with provider offices and insurance contacts for status updates
- Ensure compliance with CMS, state, and plan-specific regulations
Requirements
Hard skills
- Familiarity with prior authorization processes and portals
- Experience with EHR/UM systems (Epic, MCG, InterQual)
- Strong medical terminology knowledge
- Accurate data entry and documentation tracking
Soft skills
- High attention to detail
- Clear communication with internal and external stakeholders
- Ability to multitask and work independently
Educational requirements
- High school diploma or equivalent required
- Coursework in healthcare administration preferred
Certifications
Certification in medical billing or terminology is preferred but not required
Example 2: UM Appeals Coordinator
Position overview
The UM Appeals Coordinator supports the appeal and reconsideration process by collecting documentation, preparing case packets, and ensuring timely submission to internal reviewers and external payers. This role ensures that appeal workflows meet compliance and accreditation standards.
Responsibilities
- Organize and track appeals for denied services
- Compile medical records, physician statements, and case notes
- Coordinate with clinical reviewers and compliance staff
- Submit appeal packets within required timeframes
- Maintain logs and reporting for regulatory audits
- Communicate outcomes to appropriate parties
Requirements
Hard skills
- Knowledge of managed care regulations and appeal procedures
- Experience with document management systems
- Strong Microsoft Office skills (Excel, Outlook, Word)
Soft skills
- Strong organizational and time management skills
- Confidentiality and discretion in handling PHI
- Professional communication with providers and health plans
Educational requirements
High school diploma required; associate degree preferred
Certifications
None required, but a background in healthcare administration or compliance is valuable
Example 3: Pre-Certification Support Coordinator
Position overview
The Pre-Certification Support Coordinator facilitates the timely processing of pre-certification requests for inpatient admissions, imaging, outpatient procedures, and specialty care. They act as a liaison between referring physicians, insurance companies, and UM nurses.
Responsibilities
- Verify insurance benefits and medical necessity requirements
- Obtain pre-certifications via payer portals or by phone
- Enter approvals, denials, and pending statuses in the tracking system
- Alert clinical staff to missing or incomplete information
- Monitor turnaround times and escalate issues
- Support internal audit readiness with complete documentation
Requirements
Hard skills
- Experience with insurance verification and authorizations
- Understanding of CPT/ICD coding basics
- Proficiency in EHR systems and pre-cert tracking tools
Soft skills
- Customer service mindset when working with providers
- Ability to prioritize tasks in high-volume settings
- Dependable and deadline-oriented
Educational requirements
High school diploma or GED required
Certifications
Certification in healthcare access or patient financial services is a plus