Utilization Management Intake Coordinator

Job Description

REQUIREMENTS

• Experience in healthcare operations, utilization management, care coordination, or prior authorization
• Strong organizational and multitasking skills in a high-volume environment
• Experience working with clinical documentation or medical records
• Proficiency with healthcare systems, EHRs, and reporting tools
• Effective communication skills with providers and members
• Prior experience in Medicare Advantage or managed care
• Intake, authorization, or clinical coordination experience
• Familiarity with UM or case management workflows
• A high school diploma – Required
• 1-3 years of administrative or Medical Office experience preferable
• Proficient in technology – Google Sheets and suite of google products- Strongly Preferred
• Bilingual a plus

RESPONSIBILITIES

• Monitor intake queues including census validation checks
• Manage inbound and outbound correspondences
• Ensure referrals and cases are accurately entered into our system or re-routed to delegates as applicable
• Perform authorization set-up and case creation in our systems
• Manage and resolve authorization-related inquiries across multiple case types
• Review member inpatient status and clinical documentation to support episode updates
• Ensure required documentation is present for clinical review and determination; this includes request for information (RFI) work and electronic health record (EHR) access
• Conduct outbound calls to members and providers to obtain clinical information and communicate UM decisions
• Schedule and coordinate Peer-to-Peer (P2P) reviews between providers and Medical Directors
• Manage Medical Director case assignments and tracking
• Retrieve medical records via 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
• Daily census checks
• Assist with discharge planning coordination activities
• Support care transition workflows and case follow-up
• Download operational reports (e.g., Looker, snowflake)
• Support RFIs and case tracking in inpatient/UM tools
• Maintain accurate case status and documentation in our system
• Provide operational and administrative support to the assigned team and manager

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