Utilization Management Coordinator

Community Health Plan of Washington

Utilization Management Coordinator processing authorization requests and hospital notifications for a healthcare provider. Responsible for data entry, eligibility verification, and support to clinical staff.

Posted 7/18/2026full-timeRemote • Washington • 🇺🇸 United StatesJunior💰 $21 - $29 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in data entry, medical coding, and compliance within healthcare and managed care environments. Proficient in applying medical terminology and benefit eligibility standards to ensure accurate authorization processes.

Highest-signal resume keywords

Data EntryCPT CodingICD-10 CodingMedical TerminologyHealthcare Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

CPT CodingICD-10 CodingData EntryBenefit ValidationPrior Authorization Processing

Soft Skills

Customer ServiceResearch SkillsAttention to Detail

Tools & Technologies

Care Management SystemWeb Portal

Industry Keywords

HealthcareManaged CareWashington Apple HealthMedicare Advantage PlansNCQA

About the role

Key responsibilities & impact

Performs data entry for all referral, prior authorizations and hospital notifications; attaches and/or includes clinical documents as needed
Utilizes knowledge to determine appropriate CPT, HCPC, ICD-10 codes using CMS, NCQA and HCA criteria
Researches and validates benefit and prior authorization requirements to determine appropriate course of action within the Care Management system
Reviews, corrects, and approves authorization requests via the web portal; determines appropriate level of complexity and refers cases requiring clinical review to a nurse reviewer
Reviews completed denial letters for accuracy and adherence to compliance deadlines
Edits and proofreads content for appropriate medical terminology and MCG criteria
Ensures letters are mailed within established timeframes
Accurately applies policies & procedures, benefit and eligibility standards to all incoming requests
Conducts research, validates data, and responds to complex inquiries from multiple sources, including but not limited to members, nurses, medical providers, customer service, operations, appeals, case management and care coordination

Requirements

What you’ll need

Have an associate degree, or an equivalent combination of education and highly relevant experience
Have at least one (1) year of customer service experience, preferred
Have working experience in a Healthcare setting, preferred
Have working experience in a Managed Care setting, preferred
Are knowledgeable of medical terminology and healthcare processes, preferred
Are knowledgeable of Washington Apple Health and Medicare Advantage Plans, preferred

Benefits

Comp & perks

Medical, Prescription, Dental, and Vision
Telehealth app
Flexible Spending Accounts, Health Savings Accounts
Basic Life AD&D, Short and Long-Term Disability
Voluntary Life, Critical Care, and Long-Term Care Insurance
401(k) Retirement and generous employer match
Employee Assistance Program and Mental Fitness app
Financial Coaching, Identity Theft Protection
Time off including PTO accrual starting at 17 days per year
40 hours Community Service volunteer time
10 standard holidays, 2 floating holidays
Compassion time off, jury duty