Utilization Management Support CoordinatorJob Description, Salary, Career Path, and Trends
A utilization management support coordinator is in charge of providing both coordination and support to the utilization management processes. This utilization management support coordinator will ensure the process runs smoothly within your business, and should oftentimes be required to provide support to the required team members. The utilization management support coordination is also required to help with reviews for the proper medical procedures and appropriate actions taken.
A utilization management support coordinator can be extremely beneficial and effective at increasing team efficiency. The utilization management support coordination position requires an employee with effective teamwork and communication skills as well as the necessary understanding of utilization management.
Sample job description #1
ABC Company Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of ABC Company’s benefits plan. The Utilization Management (UM) Support Coordinator is responsible for applying clinical and benefit administration policy guidelines to requests for authorizations. The UM Support Coordinator provides accurate, prompt, and appropriate medical authorizations to requests from ABC Company Clinicians, Vendors, and Providers.
What you’ll be doing
The UM Support Coordinator reports to the Utilization Management Nurse Manager
Uses established criteria to conduct preliminary decision review for services requiring prior authorization
Applies clinical and benefit administration policy guidelines to requests for authorizations
Assesses the need for additional information to complete a service decision request
Enters authorizations into ABC Company’s data system to ensure timely review of and downstream claims processing
Works closely with UM RN staff to escalate decisions that require clinical review and oversight
Communicates results of reviews in the centralized enrollee record for the primary care team and clinical reviewers
Handles all authorization requests timely and accurately, adhering to performance measures
Follows department and organizational policies and procedures as well as adheres to all applicable regulatory, contractual, and compliance requirements
Fulfills duties as above within service standard turnaround times
What we’re looking for
Associate’s Degree or equivalent experience – Bachelor’s Degree
2+ years professional work experience in health care, managed care, or insurance
Education, training or experience as a medical coder, medical billing, Insurance Coordinator or other relevant clinical background highly preferred
Familiarity with utilization management review
Knowledge of CPT and ICD coding highly preferred
Flexibility and understanding of individualized care plans
Excellent interpersonal, verbal, and written communication skills
Ability to work independently and make decisions
Work in a team based environment
Working knowledge of and ability to navigate through the healthcare system (insurances, Medicare, Medicaid, physician office operations)
English required, bilingual preferred
Sample job description #2
This position is responsible for providing support to the Medical Management department to ensure timeliness of outpatient or inpatient referral/authorization processing per state and federal guidelines. This position performs trouble-shooting when problems situations arise and takes independent action to resolve complex issues.
Input data into the Medical Management system to ensure timeliness of referral/authorization processing
Verifies member benefits and eligibility upon receipt of the treatment authorization request
Coordinates with referral nurse and/or Medical Director for timely referral processing
Ensure timely provider and member oral and written notification of referral decisions
Ensures proper notification of patient facility admissions with PCP and NOMNC when applicable
Coordinate board certified referrals with partner vendors
Coordinates and assists with patient appointments as needed and notify patient of authorization status
Performs trouble-shooting when problems situations arise; taking independent action to resolve complex issues
Prepares denial letters for review by Medical Director or Nurse Reviewer(s) and distributes letters to appropriate recipients
Performs coordination for out-of-network cases and facilitates letters of agreement (LOA) processing in collaboration with Medical Directors and Leadership
Performs coordination of benefits
Demonstrates excellent communications skills and interpersonal relationships
Collaborates and facilitates interdisciplinary team communications
Perform additional duties as assigned
Process referrals and/ or calls within the dept. targets based on workflows and technology
Meets inter-rater minimum standards for core responsibilities
If assigned to Provider Phone Queues, Collaborates with Customer Service Representatives to provide information regarding referral/authorization processing
Appropriately tracks incoming call types and pertinent details of calls
High School Diploma or equivalent required
MA or Medical Billing Certificate preferred
Minimum 2 years of experience working in a medical billing environment (IPA or HMO preferred), with pre-authorizations and reimbursement regulations pertaining to Medi-Cal, CCS, and other government programs required
Prior experience in utilization management processing authorization referrals also required
Prefer prior Lead position experience
Sample job description #3
Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review, care coordination, and quality of care.
Performs member or provider related administrative support which may include benefit verification, authorization creation and management, claims inquiries, and case documentation
Reviews authorization requests for initial determination and/or triages for clinical review and resolution
Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information, and assisting in solving problems
Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews
Education Level: High School Diploma
Experience: 3 years experience in health care claims/service areas or office support
Two years experience in health care/managed care setting or previous work experience within division
Knowledge of CPT and ICD-10 coding
Knowledge, skills and abilities (KSAs)
Ability to effectively participate in a multi-disciplinary team including internal and external participants
Excellent communication, organizational and customer service skills
Knowledge of basic medical terminology and concepts used in managed care
Knowledge of standardized processes and procedures for evaluating medical support operations business practices
Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy
Ability to pay attention to the minute details of a project or task
Experienced in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging
Average salary and compensation
The average salary for a utilization management support coordinator is $46,900 in the United States. Position salary will vary based on experience, education, company size, industry, and market.
Los Angeles, California
Minneapolis-St. Paul, Minnesota
New York City, New York
Sample interview questions
How have you assisted with reviews of medical necessity and appropriateness in the past?
What education or experience do you have in health utilization management?
What resources do you feel are necessary to support the UM process?
What would you say is your strongest skill when it comes to utilization management?
Why are you interested in working as a utilization management support coordinator?
Do you have any experience working in a call center or office environment? If so, please describe.
How would you deal with a situation where you received conflicting information from different stakeholders?
What do you think is the most important aspect of providing quality care?
What does utilization management mean to you?
In what ways can a utilization management support coordinator impact the culture of an organization?
What personal habits or values allow you to work well within a team environment?
Why is communication important in health care and how do you ensure all those involved are on the same page?
How would your former or current manager describe you?
What is your ideal work environment and why?
Utilization Management Support Coordinator Jobs in Ashburn
Need help hiring an Utilization Management Support Coordinator?
We match top professionals with great employers across the country. Your next career move or star employee is just around the corner. Review our career content and advice, browse our latest job openings, or email us your resume. We look forward to connecting with you soon!