Utilization Management Support Coordinator in Worcester, Massachusetts at UMass Memorial Health

Description:

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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 an environment of professionalism, tolerance, civility and acceptance toward all employees, patients, and visitors.
• Maintains, regular, reliable, and predictable attendance.
• Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

II. Position Qualifications:

License/Certification/Education:

Required: Associate’s degree in health science, business or related field or equivalent combination of experience.

Preferred: Bachelor’s degree in health sciences, business or related field preferred.

Experience/Skills:

Required:

Two or more years’ experience in healthcare, medical office, patient access, revenue cycle, case management or utilization review preferred.

Experience working with insurance authorizations, payer requirements, or clinical documentation is highly desirable.

Ability to form positive, collaborative relationships with hospital staff and internal and external partners.

Strong organizational and multi-tasking skills.

Excellent verbal and written communication.

Working knowledge of medical terminology and basic clinical concepts.

Ability to interpret payer guidelines and authorization requirements.

Proficiency with EMR systems (Epic preferred), Microsoft Office tools.

Ability to work collaboratively with nurses, Physicians, payers and non-clinical staff.

Detail-oriented with strong follow-through.

Ability to work independently.

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

Physical Demands and Environmental Conditions:

• Work is considered sedentary.
• This position follows a hybrid work model, with the majority of work performed remotely. Periodic onsite presence is required, typically approximately one day per week, or as operational needs require.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.

About Us:

At UMass Memorial Health, everyone is a caregiver. No matter their responsibilities or title, every employee or "caregiver" fills an important role for our patients and their families every day. Who is a caregiver? It's not just the person who delivers the care. It's all the people who make it work ... and make it better. Caregivers give everything that helps patients heal, from expertise to extra attention. They give clean, comfortable rooms. Fast, accurate answers. And an easier, less stressful experience. They give warm, reassuring smiles, and helping hands. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, our community and each other. And everyone, in their own unique way, plays an important part, every day.