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Exemption Status:

Non-Exempt

Hiring Range:

$30.91 - $46.03

Please note that the final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations.

Schedule Details:

Monday through Friday

Scheduled Hours:

8:30-5pm

Shift:

1 - Day Shift, 8 Hours (United States of America)

Hours:

40

Cost Center:

99940 - 5421 Utilization Management

Union:

SHARE (State Healthcare and Research Employees)

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

The Utilization Management Coordinator supports the organization’s Utilization Management (UM) program by coordinating payer communications, assisting with clinical review and authorization workflows, and ensuring accurate documentation and tracking within the electronic medical record. The role works closely with Utilization Review Specialists, Physician Advisors, Case Management, and Revenue Cycle teams to support medical necessity review processes, patient status management, and timely response to payer requests.

This position also provides administrative support for Physician Advisor activities, clinical denial management, reporting, and Utilization Review Committee operations, helping ensure efficient UM processes and compliance with CMS and payer requirements.

I. Major Responsibilities:

• Supports daily Utilization Management (UM) operations, including coordination of payer communications, authorization tracking, and submission of clinical documentation for medical necessity reviews.
• Assists Utilization Review Specialists and Physician Advisors by facilitating clinical review workflows, tracking determinations, and coordinating peer-to-peer discussions when required.
• Maintains accurate documentation of payer communications, authorization information, and level-of-care determinations in the electronic medical record in accordance with departmental standards.
• Serves as a liaison between the organization and insurance payers, third-party reviewers, and audit entities, ensuring timely response to requests and follow-up on review outcomes.
• Provides administrative and operational support for the Physician Advisor program, including schedule coordination, activity tracking, and preparation of utilization and peer-to-peer outcome reports.
• Supports clinical denial management and appeal processes, including coordination of documentation, submission of appeals, and tracking of determinations and audit activity.
• Assists with data tracking, reporting, and preparation of materials for Utilization Review Committee meetings and departmental performance monitoring.
• Maintains departmental payer reference tools, workflows, and program documentation that support UM operations and regulatory compliance.
• Collaborates with Case Management, Revenue Cycle, Patient Access, Coding, and other operational teams to support accurate patient status determination and efficient review processes.
• Ensures processes align with CMS, state, and commercial payer requirements and participates in process improvement initiatives related to utilization management.

Standard Staffing Level Responsibilities: 

• Follows departmental policies and procedures.
• Attends variety of meetings as required or directed.
• Demonstrates use of Quality Improvement in daily operations.
• Comply with all health and safety regulations and requirements.
• Respects diverse views and approaches, demonstrate Standards of Respect, and contributes to creating and maintaining a