Utilization Management Intake Coordinator- REMOTE

Job Description

Schedule:

This role supports our weekend operations and requires availability every Saturday and Sunday. The weekly schedule is a 5-day (8-hour) schedule, totaling 40 hours per week. Shifts are scheduled within the hours of 8:00 AM–8:00 PM ET.

A bit about this role: 

The Utilization Management Coordinator plays a vital role in supporting Clinical Operations by managing the intake, prior authorization, and clinical coordination workflows. This role ensures timely case intake, accurate authorization set-up, and effective coordination with members, providers, and internal clinical teams to support care transitions and authorization processes. The coordinator will be an important part of building strong relationships with health care providers through proactive communication, managing key operational processes to enable efficient, high-quality clinical decisions. This is a fast-paced environment at a startup that requires exceptional organization, attention to detail, and a natural talent for customer service. We often require management of several tasks at once so enthusiasm and organization are key.

Core Responsibilities: Intake, Clinical Coordination & Prior Authorization

Intake Management

• Monitor intake queues including census validation checks

• Manage inbound and outbound correspondences 

• Ensure referrals and cases are accurately entered into our system or re-routed to delegates as applicable

Prior Authorization Support

• Perform authorization set-up and case creation in our systems

• Manage and resolve authorization-related inquiries across multiple case types

• Review member inpatient status and clinical documentation to support episode updates

• Ensure required documentation is present for clinical review and determination; this includes request for information (RFI) work and electronic health record (EHR) access 

Clinical Coordination & Communication

• Conduct outbound calls to members and providers to obtain clinical information and communicate UM decisions

• Schedule and coordinate Peer-to-Peer (P2P) reviews between providers and Medical Directors

• Manage Medical Director case assignments and tracking

• Retrieve medical records via hospital EHR portals and external systems

• Support the Clinical Team with case coordination and documentation needs

Post-Discharge & Transitional Care Coordination

• Contact inpatient and post-acute facilities to confirm admission and discharge details

• Daily census checks 

• Assist with discharge planning coordination activities

• Support care transition workflows and case follow-up

Operational & Reporting Support

• Download operational reports (e.g., Looker, snowflake)

• Support RFIs and case tracking in inpatient/UM tools

• Maintain accurate case status and documentation in our system

• Provide operational and administrative support to the assigned team and manager

Required skills and experience: 

• Experience in healthcare operations, utilization management, care coordination, or prior authorization

• Strong organizational and multitasking skills in a high-volume environment

• Experience working with clinical documentation or medical records

• Proficiency with healthcare systems, EHRs, and reporting tools

• Effective communication skills with providers and members

Desired skills and experience: 

• Prior experience in Medicare Advantage or managed care

• Intake, authorization, or clinical coordination experience

• Familiarity with UM or case management workflows

• A high school diploma - Required

• 1-3 years of administrative or Medical Office experience preferable

• Proficient in technology - Google Sheets and suite of google products- Strongly Preferred

• Bilingual a plus

Key Co