Utilization Management Coordinator II

GuideWell Source

. Process provider prior authorization requests to support quality clinical outcomes for health plan members .

Posted 10/3/2026full-timeFlorida • United StatesJuniorMid-Level💰 $19 - $30 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in processing prior authorization requests and managing clinical referrals while ensuring quality clinical outcomes. Proficient in medical terminology and effective communication with various stakeholders to resolve issues and provide customer service.

Highest-signal resume keywords

Prior Authorization ProcessingMedical Terminology KnowledgeMicrosoft Office Suite ProficiencyCustomer Service SkillsAnalytical Problem-Solving

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Prior Authorization RequestsClinical Referrals ManagementInsurance Coverage VerificationDocumentation EntryMedical Review Coordination

Soft Skills

Strong Interpersonal SkillsExcellent Oral CommunicationExcellent Written CommunicationOrganizational SkillsSound Judgment

Tools & Technologies

Electronic Medical Record ProgramsDocumentation Programs

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Health PlanUtilization ManagementClinical OutcomesBenefit EligibilityProvider Interaction

About the role

Key responsibilities & impact

Process provider prior authorization requests to support quality clinical outcomes for health plan members
Coordinate, generate and track correspondence, faxes and authorizations for pre-service, concurrent and post-service reviews
Interact with facilities, vendors, providers and staff to obtain information and records for prompt review and response
Provide telephone customer service to members and providers, answer benefit questions, research and resolve issues, and explain products and services
Determine contract and benefit eligibility
Initiate and manage clinical referrals
Verify insurance coverage and obtain authorizations when needed
Process prior authorization requests received by phone, fax or correspondence
Forward authorization requests to clinicians for medical review
Enter referrals and document communications, actions and other data in departmental systems
Provide authorization for inpatient admission, outpatient certification and prior authorization requests
Perform assigned UM Coordinator activities and support unit goals during staffing or technology concerns
Meet or exceed proficiency, productivity and accuracy standards
Act as liaison between hospitals, physicians, health plans, vendors, patients and referral sources
Assist with daily management of UM Coordinators as needed
Provide onboarding training and precept new staff
Provide guidance and expertise to less experienced UM Coordinators

Requirements

What you’ll need

2+ years related work experience
High school diploma or GED
Strong analytical skills and ability to use sound judgment and resolve problems with minimal guidance or supervisor
Ability to use sound judgment and resolve problems with moderate guidance from lead staff and/or supervisor
Skills to communicate effectively to all levels of employees
Excellent oral and written communication skills
Excellent organizational skills
Strong interpersonal skills
Knowledge of medical terminology required
Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint)
Familiarity with medical management, electronic medical record and documentation programs
Consistent word processing speed and accuracy of 50 or more words per minute

Benefits

Comp & perks

Medical, dental, vision, life and global travel health insurance
Short- and long-term disability programs
Leave programs to support personal circumstances
Retirement Savings Plan including employer match
Paid time off
Volunteer time off
10 holidays
2 well-being days
Additional voluntary benefits
Comprehensive wellness program
Opportunities for incentive or commission compensation
Annual reviews with pay-for-performance considerations for base pay increases
Hybrid work arrangement combining flexibility with in-office engagement