Utilization Management Coordinator

Virtual - Arizona

About the role

At HonorHealth, you’ll find something special. From humble beginnings in 1927 to one of Arizona’s largest nonprofit healthcare systems, our culture is built on warmth and neighborly kindness. Behind every smile is a highly skilled professional with deep expertise and an unwavering dedication to what matters most — caring for the health and well-being of people and communities across the greater Phoenix area.

Under the direction of the Network Manager for Utilization Management, this position assists in the administration of Utilization Management functions, including organization and prioritization of workflow, internal and external department communications, critical information interpretation and tracking follow-up, research, and report creation. The role primarily supports UM operations and communication with payers to effectively gain approval of admissions via the clinical review and appeal processes. Secondarily, it supports Care Coordination department efforts in optimizing department communications from payers in an efficient and effective workflow process.

Responsibilities

• Performs a variety of routine clerical and revenue-optimizing activities according to department workflows and meets defined productivity standards.
• Works accounts from assigned work queues (WQs).
• Monitors RightFax daily for inbound faxes from payers; renames inbound faxes adhering to department naming conventions.
• Uploads payer approvals, bed days, and denials to the appropriate patient’s account.
• Documents EMR/EPIC Auth/Cert and Communications.
• Faxes initial or continued stay clinicals to payers, ensuring payer requirements are met, and follows up on fax failures until resolved.
• Handles HIPAA breaches by filling out the Compliance department breach reporting form and submitting chart corrections.
• Communicates with the Preservices team if a patient’s coverage is terminated or unclear.
• Continuously monitors deferred accounts and follows up with payers to obtain additional approved days.
• Collaborates with external payers to secure approvals and with internal team members, UM nurses, and others in Care Coordination departments to support revenue optimization.
• Communicates barriers and escalates issues in all areas of responsibility.
• Facilitates clinical data requests and documents appropriately.
• Coordinates concurrent denial resolution with nursing and physician advisor teams.
• Facilitates peer-to-peer reviews with payers as directed.
• Retrieves utilization management clinical requests and handles each appropriately according to department standards.
• Escalates patient calls to leadership and documents in EPIC/EMR.
• Performs other duties as assigned (e.g., reports, research, meeting scribe, new hire onboarding).

Requirements

• High School Diploma or GED – Required
• Associate's Degree – Preferred
• 1 year of clerical support – Required
• 1 year of administrative support in a healthcare field (e.g., case management, utilization review, medical insurance, medical office front desk, hospital business office, preservices, admitting, registration, billing, collections) – Preferred