Employment Type:
Full time
Shift:
Description:
Utilization Management Assistant
***Prior Authorization Requests***
Department: Care Coordination
Shift: FT Days (8 hours)
Position Summary
The Utilization Management Assistant provides administrative and clinical support for utilization review activities, working closely with UM nurses, physicians, and care teams. This role helps ensure timely authorizations, accurate documentation, and coordination of high‑quality, cost‑effective patient care.
Key Responsibilities
- Initiate and process authorizations for admissions and medical services.
- Review medical records and extract key information to support utilization review.
- Assist with communication to internal and external providers regarding benefits, approvals, denials, and care processes.
- Notify external entities of discharges and post‑acute transitions.
- Support quality and performance improvement initiatives.
- Gather documentation for service denials and escalate concerns appropriately.
- Collaborate with Care Management and Population Health teams on process improvements.
Qualifications
- 1–2 years’ experience as an LPN, Medical Assistant, CNA, or similar healthcare role.
Required:
- MA or CNA certification or LPN license (active, unrestricted).
- High school diploma or GED (for MA/CNA roles).
- Experience with utilization management, concurrent review, or discharge coordination preferred.
- Strong computer skills, including Microsoft Excel, Word, and electronic systems.
- Excellent communication, organization, and attention to detail.
- Mandatory Reporter training within 3 months of hire.
Work Environment
- Frequent walking, standing, typing, phone use, and medical record review.
- Medium work: lifting up to 50 lbs occasionally.
- Potential exposure to infectious materials and clinical hazards.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. 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 status protected by federal, state, or local law.