Utilization Management Clinical Coordinator

Progyny, Inc.

. Provide timely medical reviews and clinical determinations based on evidence-based criteria and authorization guidelines .

Posted 10/2/2026full-timeRemote • United StatesMid-LevelSenior💰 $85,000 - $100,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical reviews and clinical determinations, with a strong foundation in nursing and utilization management. Proficient in managing workflows, communication with providers, and compliance with PHI/HIPAA regulations.

Highest-signal resume keywords

Bachelor's Degree In Nursing3+ Years Of Fertility Nursing ExperienceCurrent Licensed Professional Registered NurseKnowledge Of CPT, HCPCS, And ICD-10 CodesUtilization Management Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical ReviewsClinical DeterminationsReporting And Dashboard ManagementDocumentation CategorizationWorkflow Management

Soft Skills

Strong Communication SkillsAttention To DetailMultitasking And Prioritization SkillsAbility To Work Independently

Tools & Technologies

SalesforceMicrosoft Office SuiteJIRA

Certifications & Qualifications

Licensed Professional Registered Nurse

Industry Keywords

Utilization ManagementPHIHIPAAFertility NursingAuthorization Guidelines

About the role

Key responsibilities & impact

Provide timely medical reviews and clinical determinations based on evidence-based criteria and authorization guidelines
Conduct daily, weekly, and quarterly reporting in coordination with client service-level agreements
Outreach to and educate providers to obtain required authorization documentation
Coordinate and schedule peer-to-peer reviews and appeal appointments between physicians
Track and record quarterly compensation/reimbursement
Coordinate with Independent Review Organizations to ensure timely appeals processing and audit utilization case management for specific states
Organize and present quarterly and annual audits
Process incoming and outgoing correspondence and faxes within required standards and timelines
Manage multi-step workflows and delegate tasks to the appropriate workstream
Communicate and escalate potential enhancements to internal and external processes
Categorize documentation in accordance with PHI/HIPAA restrictions
Serve as backup for the utilization associate

Requirements

What you’ll need

Bachelor’s degree in nursing
3+ year of fertility nursing experience
Current licensed professional registered nurse
Knowledge of CPT, HCPCS, and ICD-10 codes
Understanding of medical terminology
Strong communication and presentation skills
Strong attention to detail
Excellent written and verbal communication skills
Ability to communicate effectively and thoughtfully with providers and patients regarding authorization requests and determinations
Ability to work independently with minimal supervision and escalate when necessary
Strong multitasking and prioritization skills
Experience working with CRM platforms, specifically Salesforce, and reporting/dashboard management
Experience with CRM platforms/JIRA as it relates to bug reporting
Experience with Microsoft Office Suite, including Excel, Word, PowerPoint, and Outlook
Ability and willingness to learn new programs and platforms to optimize UM workflow/member experience
Utilization management experience preferred
Must be based in the United States
Must be authorized to work in the United States without sponsorship, now or in the future

Benefits

Comp & perks

Paid family and parental leave
Preconception, fertility and family building benefits, including egg freezing, IVF, and adoption support
Family and pet care fund
Parents’ Employee Affiliation Group
Menopause and midlife care
Health, dental, vision and life insurance options for employees and family
Free in-person, virtual and text-based mental health and wellness support
Paid time off, including vacation, sick leave, personal days and summer flex time
Company equity
Bonus program
401(k) plan with company match
Access to on-demand legal and financial advice
Learning and development programs
Mentorship program
Company social events, including annual volunteer day and donation matching
Flex days (3 days a week in the office)
Onsite meals and snacks for employees reporting into our NY office