Coordinator, Utilization Management

About the Company

The organization supports healthcare clients in improving financial performance across the reimbursement cycle. Its approach combines scalable service models, clinical know-how, analytics, and technology to address changing program needs while staying focused on measurable outcomes. The company also emphasizes long-term career growth by investing in employee development and creating an environment that supports both professional and personal progress.

Role Summary

This remote role focuses on utilization management coordination, with responsibility for managing the authorization workflow from start to finish. The position is based in the United States and follows a Tuesday through Saturday schedule, 8:00 AM to 5:00 PM EST, with occasional holiday coverage.

Key Responsibilities

• Oversee the full authorization cycle, including intake, data entry, submission of supporting information, follow-up, determination, and discharge-related actions.
• Keep accurate and detailed records in the EMR, the internal system, and payer portals.
• Confirm patient eligibility and benefit coverage.
• Serve as the communication link between hospital teams and health payers to move cases forward within required timelines.
• Review and apply timely-filing rules related to utilization management.
• Monitor pending authorizations and follow up with payers to support prompt responses.
• Reach out to payers to obtain updates, clarify decisions, and remove barriers affecting processing.
• Spot issues that could lead to delays or denials and escalate them appropriately.
• Manage a personal queue of accounts with timely follow-up and careful documentation.
• Follow HIPAA requirements and other applicable healthcare regulations.

Requirements

• High school diploma or an equivalent credential is required; an associate degree in healthcare administration or a similar field is preferred.
• At least 2 years of experience in hospital billing, follow-up, healthcare operations, or authorization-related work.
• Working knowledge of managed care contracts.
• Background in customer support or client issue resolution.
• Good understanding of medical terminology and insurance processes.
• Hands-on experience with EMR systems, with Epic preferred.
• Strong written and verbal communication abilities.
• Solid organizational skills and the ability to juggle multiple priorities in a fast-moving setting.
• Comfort with MS Office and web-based systems.
• Ability to work at a computer for 6 to 8 hours per day, handle frequent interruptions, remain seated for long periods, and occasionally lift up to 20 lbs.

Perks and Benefits

• Remote work available within the United States only.
• Company-provided equipment.
• Medical, dental, and vision coverage.
• 401(k) retirement plan.
• 80 hours of PTO accrued annually.
• 9 paid company holidays each year.
• Life insurance coverage.
• Short-term and long-term disability options.
• Tuition reimbursement.
• Opportunities for professional growth.

Additional Information

This position is intended as a general guide to the role and is not a complete list of every task, duty, or qualification. The employer may assign additional functions or requirements as needed. Reasonable accommodations may be made for individuals with disabilities to perform the essential duties.

Work Schedule

Required shift: Tuesday to Saturday, 8:00 AM to 5:00 PM EST. Some holiday coverage is required.

Compensation

Hourly pay is listed at $19.00 to $20.00 per hour.