Utilization Management Coordinator

Devoted Health • Waltham, MA

2d • $22 - $27 • Remote

About The Position

The Utilization Management Coordinator supports Clinical Operations by managing intake, prior authorization, and clinical coordination workflows. The role helps ensure timely case intake, accurate authorization setup, and effective coordination with members, providers, and internal clinical teams to support care transitions and authorization processes. It also builds provider relationships through proactive communication and manages operational processes that enable efficient, high-quality clinical decisions. This fast-paced role requires strong organization, attention to detail, customer service, and the ability to manage several tasks at once. The work takes place in a heavily regulated environment that may involve changing guidance and periodic CMS audits.

This is a full-time remote position, five 8-hour days per week. Shifts are assigned between 8:00 AM and 8:00 PM ET, with schedules intended to provide seven-day coverage. Available schedules are Monday–Friday, Tuesday–Saturday, and Sunday–Thursday. Candidates are asked about schedule preferences, though availability may change as positions are filled.

The role includes intake and authorization work, clinical coordination and communication, post-discharge and transitional care coordination, and operational reporting and administrative support. Compensation is listed at $21.70–$27.00 per hour. Actual base pay depends on factors including qualifications, relevant experience, skills, education, credentials, and work location.

Requirements

• High school diploma or equivalent.
• Experience in healthcare operations, utilization management, care coordination, or prior authorization.
• Proficiency with healthcare systems, electronic health records, 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 skills in a frequently changing environment.

Nice To Haves

• Prior experience in Medicare Advantage or managed care.
• Intake, authorization, or clinical coordination experience.
• Familiarity with utilization management or case management workflows.
• 1–3 years of administrative or medical office experience.
• Proficiency with Google Sheets and the Google Workspace suite.
• Bilingual.

Responsibilities

• Monitor intake queues, including daily census validation checks.
• Manage inbound and outbound correspondence.
• Enter referrals and cases accurately into systems or reroute them to delegates as applicable.
• Set up authorizations and create cases in the relevant systems.
• Manage and resolve authorization-related inquiries across multiple case types.
• Review member inpatient status and clinical documentation to support episode updates.
• Ensure documentation required for clinical review and determinations is present, including handling requests for information and obtaining electronic health record access.
• Call members and providers to obtain clinical information and communicate utilization management decisions.
• Schedule and coordinate peer-to-peer reviews between providers and Medical Directors.
• Manage Medical Director case assignments and tracking.
• Retrieve medical records through hospital EHR portals and external systems.
• Support the clinical team with case coordination and documentation needs.
• Contact inpatient and post-acute facilities to confirm admission and discharge details.
• Complete daily census checks and assist with discharge planning coordination.
• Support care-transition workflows and case follow-up.
• Download and review operational reports, such as Looker and Snowflake reports.
• Support requests for information and case tracking in inpatient and utilization management tools.
• Maintain accurate case status and documentation in the system.
• Provide operational and administrative support to the assigned team and manager.
• Participate in team research and root-cause work during periodic CMS audits.

Benefits

• Employer-sponsored health, dental, and vision plans with low or no premium.
• Generous paid time off.
• $100 monthly mobile or internet stipend.
• Stock options for all employees.
• Bonus eligibility for roles below Director level; commission eligibility for Sales roles.
• Parental leave program.
• 401(k) program.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED