Utilization Management Coordinator

Utilization Management (UM) Coordinator

Harbor Health

POSITION OVERVIEW

The UM Coordinator position provides administrative and operational support to the Utilization Management team. This role assists with intake and setup of authorization requests, coordination of clinical information, documentation of case activity and communication with Healthcare providers and members.

The UM Coordinator ensures that authorization cases are accurately documented and tracked throughout the utilization review process while supporting the UM team in obtaining necessary information for timely determinations by the UR vendor. This role requires strong organizational skills, attention to detail, and the ability to communicate effectively with internal teams, healthcare facilities and providers, and health plan members.

POSITION DUTIES & RESPONSIBILITIES

Utilization Management Coordination

• Monitor incoming notifications for prior authorization, inpatient admissions, and transition of care requests.

• Assist with creating and initiating authorization cases in the UM platform, ensuring accurate entry of required information.

• Track authorization requests and maintain detailed case documentation throughout the utilization review workflow.

• Ensure all required clinical documentation and supporting records are obtained and properly uploaded into the UM system.

• Maintain internal tracking tools and spreadsheets to support authorization tracking and case workflow management.

• Prepare cases for review by organizing documentation and updating case status for UR vendor.

Facility & Member Communication

• Contact healthcare facilities, provider offices, and hospitals to obtain clinical information required for authorization review.

• Communicate with members to address needs, provide updates, or obtain required information related to their case.

• Document all communications with members, providers, and facilities in the UM system or internal tracking tools.

• Escalate issues or urgent clinical needs to the appropriate UM team member.

Compliance & Quality

• Ensure all documentation and workflows follow organizational policies, payer requirements, and regulatory standards.

• Maintain confidentiality and comply with HIPAA regulations.

• Assist with audits and reporting as needed.

DESIRED PROFESSIONAL SKILLS & EXPERIENCE

Required Qualifications

• Medical Assistant (MA) certification or equivalent clinical support experience

• 3–5 years of experience in care coordination and/or utilization management

• Knowledge of medical terminology

• Experience with utilization management platforms

• Strong organizational and documentation skills

• Excellent verbal and written communication skills

Preferred Qualifications

• Experience communicating with healthcare facilities, insurance payers, and patients/members

• Familiarity with authorization workflows or case management systems

Key Skills

• Attention to detail

• Documentation accuracy

• Communication and member engagement

• Coordination and workflow management

• Time management and multitasking

WHAT WE OFFER

• Competitive salary and benefits package

• Generous PTO

• 10 paid holidays

• Medical, Dental, and Vision Insurance

• 401(k) Investment Plan

• Professional development and growth opportunities

• A transparent and unique culture

• Collaborative and dynamic work environment

COMPANY OVERVIEW

At Harbor Health, we're transforming healthcare in Texas through collaboration and innovation. We're seeking passionate individuals to help us create a member-centered experience that connects comprehensive care with a modern payment model. If you're ready to make a meaningful impact in a dynamic environment where your contributions are valued, please bring your talents to our team!

EQUAL EMPLOYMENT OPPORTUNITY

Harbor Health is an Equal Opportunity Employer. We celebrate diversity and are committed to building an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic.