Utilization Management Coordinator PRN

About the role

Supports insurance and clinical review processes by managing communication, documentation, and coordination with insurance companies to ensure timely approvals and accurate record-keeping.

Responsibilities

• Assist with faxing initial, concurrent, or discharge reviews to insurance providers.
• Document submissions and communications in Epic system.
• Manage phone and fax lines, scan documents, and perform clerical tasks to facilitate utilization management.
• Communicate with insurance companies to obtain authorizations and respond to clinical review requests within contractual timeframes.
• Generate and submit Epic reports related to third-party payers.
• Monitor departmental productivity and quality metrics, ensuring compliance with regulations.
• Notify payors of patient admissions and update communication records in Epic.
• Perform additional duties as assigned to support daily operations.

Requirements

• High School Diploma required; some college preferred.
• Minimum of 5 years of hospital or insurance industry experience.

Skills

• Strong communication skills and familiarity with Epic system.
• Ability to handle multiple tasks efficiently and adhere to deadlines.