[Hiring] Utilization Management Coordinator @The Harbor Health Team

Role Description

The UM Coordinator position provides administrative and operational support to the Utilization Management team. This role assists with intake and setup of authorization requests, coordination of clinical information, documentation of case activity and communication with Healthcare providers and members.

The UM Coordinator ensures that authorization cases are accurately documented and tracked throughout the utilization review process while supporting the UM team in obtaining necessary information for timely determinations by the UR vendor. This role requires strong organizational skills, attention to detail, and the ability to communicate effectively with internal teams, healthcare facilities and providers, and health plan members.

Qualifications

• Medical Assistant (MA) certification or equivalent clinical support experience
• 3–5 years of experience in care coordination and/or utilization management
• Knowledge of medical terminology
• Experience with utilization management platforms
• Strong organizational and documentation skills
• Excellent verbal and written communication skills

Requirements

• Monitor incoming notifications for prior authorization, inpatient admissions, and transition of care requests.
• Assist with creating and initiating authorization cases in the UM platform, ensuring accurate entry of required information.
• Track authorization requests and maintain detailed case documentation throughout the utilization review workflow.
• Ensure all required clinical documentation and supporting records are obtained and properly uploaded into the UM system.
• Maintain internal tracking tools and spreadsheets to support authorization tracking and case workflow management.
• Prepare cases for review by organizing documentation and updating case status for UR vendor.
• Contact healthcare facilities, provider offices, and hospitals to obtain clinical information required for authorization review.
• Communicate with members to address needs, provide updates, or obtain required information related to their case.
• Document all communications with members, providers, and facilities in the UM system or internal tracking tools.
• Escalate issues or urgent clinical needs to the appropriate UM team member.
• Ensure all documentation and workflows follow organizational policies, payer requirements, and regulatory standards.
• Maintain confidentiality and comply with HIPAA regulations.
• Assist with audits and reporting as needed.

Benefits

• Competitive salary and benefits package
• Generous PTO
• 10 paid holidays
• Medical, Dental, and Vision Insurance
• 401(k) Investment Plan
• Professional development and growth opportunities
• A transparent and unique culture
• Collaborative and dynamic work environment

Company Description

At Harbor Health, we're transforming healthcare in Texas through collaboration and innovation. We're seeking passionate individuals to help us create a member-centered experience that connects comprehensive care with a modern payment model. If you're ready to make a meaningful impact in a dynamic environment where your contributions are valued, please bring your talents to our team!