Utilization Management Support Coordinator

UMass Memorial Health•Worcester, MA

1d•$31 - $46•Hybrid

About The Position

The Utilization Management Coordinator supports the organization’s Utilization Management (UM) program by coordinating payer communications, assisting with clinical review and authorization workflows, and ensuring accurate documentation and tracking within the electronic medical record. The role works closely with Utilization Review Specialists, Physician Advisors, Case Management, and Revenue Cycle teams to support medical necessity review processes, patient status management, and timely response to payer requests. This position also provides administrative support for Physician Advisor activities, clinical denial management, reporting, and Utilization Review Committee operations, helping ensure efficient UM processes and compliance with CMS and payer requirements.

Requirements

Associate’s degree in health science, business or related field or equivalent combination of experience.
Two or more years’ experience in healthcare, medical office, patient access, revenue cycle, case management or utilization review preferred.
Experience working with insurance authorizations, payer requirements, or clinical documentation is highly desirable.
Ability to form positive, collaborative relationships with hospital staff and internal and external partners.
Strong organizational and multi-tasking skills.
Excellent verbal and written communication.
Working knowledge of medical terminology and basic clinical concepts.
Ability to interpret payer guidelines and authorization requirements.
Proficiency with EMR systems (Epic preferred), Microsoft Office tools.
Ability to work collaboratively with nurses, Physicians, payers and non-clinical staff.
Detail-oriented with strong follow-through.
Ability to work independently.
Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Nice To Haves

Bachelor’s degree in health sciences, business or related field preferred.

Responsibilities

Supports daily Utilization Management (UM) operations, including coordination of payer communications, authorization tracking, and submission of clinical documentation for medical necessity reviews.
Assists Utilization Review Specialists and Physician Advisors by facilitating clinical review workflows, tracking determinations, and coordinating peer-to-peer discussions when required.
Maintains accurate documentation of payer communications, authorization information, and level-of-care determinations in the electronic medical record in accordance with departmental standards.
Serves as a liaison between the organization and insurance payers, third-party reviewers, and audit entities, ensuring timely response to requests and follow-up on review outcomes.
Provides administrative and operational support for the Physician Advisor program, including schedule coordination, activity tracking, and preparation of utilization and peer-to-peer outcome reports.
Supports clinical denial management and appeal processes, including coordination of documentation, submission of appeals, and tracking of determinations and audit activity.
Assists with data tracking, reporting, and preparation of materials for Utilization Review Committee meetings and departmental performance monitoring.
Maintains departmental payer reference tools, workflows, and program documentation that support UM operations and regulatory compliance.
Collaborates with Case Management, Revenue Cycle, Patient Access, Coding, and other operational teams to support accurate patient status determination and efficient review processes.
Ensures processes align with CMS, state, and commercial payer requirements and participates in process improvement initiatives related to utilization management.
Follows departmental policies and procedures.
Attends variety of meetings as required or directed.
Demonstrates use of Quality Improvement in daily operations.
Comply with all health and safety regulations and requirements.
Respects diverse views and approaches, demonstrate Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients, and visitors.
Maintains, regular, reliable, and predictable attendance.
Performs other similar and related duties as required or directed.