Utilization Management Coordinator

Summary

Join Integra Partners as a UM Coordinator and support the clinical team with administrative and non-clinical tasks related to utilization management. Monitor incoming faxes, enter authorization requests, verify eligibility and documentation, and contact providers to obtain necessary information. Generate correspondence, make outbound calls, and document in the authorization platform. Initiate appeals and meet deadlines while completing tasks assigned by UM Nurses. Handle inquiries from various sources and maintain professional communication with clients. This role requires a high school diploma, at least one year of experience in a similar role, and proficiency in using healthcare software and Microsoft Office Suite.

Requirements

• High school diploma required
• At least 1 year of experience as a UM Coordinator or similar administrative role within a health plan, managed care organization, or delegated UM entity
• Familiarity with the UM process, including how authorization requests, appeals, and peer-to-peer reviews are routed and tracked within an authorization system
• Comfortable working with clinical documentation (e.g. provider office notes, prescriptions, therapy assessments, sleep studies), with the ability to identify required components for submission
• Experience working with ICD-10 and HCPCS codes, including verifying code accuracy, benefit limits, and documentation requirements
• Able to use a fee schedule to confirm benefit coverage and determine allowable quantities or limits
• Strong organizational and time management skills with the ability to prioritize and track multiple UM cases or requests simultaneously
• Proficient computer skills required, including Microsoft Word, Outlook, and experience navigating healthcare software or authorization systems
• Able to review documentation and cross-reference with policy or system requirements to confirm completeness, not for medical necessity
• Strong written and verbal communication skills for professional interactions with providers and internal clinical staff

Responsibilities

• Monitor incoming faxes
• Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes
• Verify eligibility and claim history in proprietary claims platform
• Verify all necessary documentation has been submitted with authorization requests
• Contact requesting providers to obtain medical records or other necessary documentation related to specific UM request
• Generate correspondence and assist with faxing/mailing member and provider notifications
• Make outbound calls to providers and members for verbal notification
• Make outreach including faxes and calls for more documentation
• Document as required in authorization platform
• Initiate appeal cases and forward to UM Nurses for completion
• Meet internal and regulator deadlines for UM cases
• Complete tasks assigned by UM Nurses and document as required
• Complete inquiries received from call center and other internal & external sources
• Other duties as assigned by UM Leadership
• Ability to communicate with clients in a professional manner
• Strong organizational skills, ability to adapt quickly to change and desire to work in a fast-paced environment
• Team oriented and self-motivated with a positive attitude

Preferred Qualifications

• Experience with DMEPOS authorization workflows preferred
• Familiarity with Medicare and/or Medicaid UM processes is preferred

Benefits

• Competitive compensation and annual bonus program
• 401(k) retirement program with company match
• Company-paid life insurance
• Company-paid short term disability coverage (location restrictions may apply)
• Medical, Vision, and Dental benefits
• Paid Time Off (PTO)
• Paid Parental Leave
• Sick Time
• Paid company holidays and floating holidays
• Quarterly company-sponsored events
• Health and wellness programs
• Career development opportunities
• Remote Opportunities