Utilization Management Coordinator

Independent Living Systems • Miami, FL

22h

About The Position

Independent Living Systems (ILS), along with its affiliated health plans Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for vulnerable populations. The Utilization Management Coordinator helps ensure authorization requests are processed effectively and timely. The role reviews prior authorization forms for documentation completeness and determines whether requested services require authorization. It includes inbound and outbound communication with internal and external customers and supports improved member outcomes by facilitating timely access to necessary care.

Requirements

• High school diploma or equivalent; relevant experience may substitute for the education requirement on a year-for-year basis.
• Two years of experience as a medical office referral/authorization clerk, office assistant, or in another medical office role.
• Strong knowledge of healthcare regulations and medical terminology.

Nice To Haves

• Associate degree in Health Administration or a related healthcare field.
• Certification in Utilization Review, such as Certified Professional in Utilization Review (CPUR), or Case Management, such as CCM.
• Experience working within managed care organizations or health insurance companies.
• Familiarity with Florida Medicaid/SMMC and CMS guidelines, HIPAA, and current health plan accreditation standards.

Responsibilities

• Demonstrate commitment to the organization’s mission and model ILS Experience Standards of Excellence.
• Continuously review prior authorization requests received via oral communication, provider portal, fax, and/or email to ensure timely processing.
• Screen prior authorization requests for appropriate referral to the Clinical Care Specialist.
• Perform non-medical research, including eligibility verification and review of the prior authorization grid to confirm whether services require prior authorization.
• Place outbound calls to providers to request clinical information for review.
• Perform other duties as assigned.

What This Job Offers

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