Utilization Management Coordinator

Saint Francis Health System

. Provide administrative and clinical support throughout patient reviews, placement in levels of care, receipt of necessary services, and discharge planning .

Posted 10/19/2026part-timeRemote • Oklahoma • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical support and utilization management within behavioral health, ensuring compliance with managed care standards and effective communication with treatment teams. Proficient in data analysis and process improvement to enhance patient care and discharge planning.

Highest-signal resume keywords

Registered Nurse LicenseLCSW, LPC, or LMFT LicenseBehavioral Health Managed Care ExperienceUtilization Management ProceduresData Analysis Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical SupportUtilization ReviewPatient Care CoordinationData AnalysisInsurance AppealsDischarge PlanningQuality ImprovementEligibility VerificationManaged Care ComplianceBehavioral Health Standards

Soft Skills

Effective CommunicationInterpersonal SkillsOrganizational SkillsDetail-OrientedPrioritization Skills

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft Access

Certifications & Qualifications

Registered Nurse LicenseLCSW LicenseLPC LicenseLMFT License

Industry Keywords

Behavioral Health CareUtilization ManagementManaged CarePatient Care CommitteeQuality Improvement

About the role

Key responsibilities & impact

Provide administrative and clinical support throughout patient reviews, placement in levels of care, receipt of necessary services, and discharge planning
Participate in treatment teams and communicate reimbursement issues to providers
Participate in the Patient Care Committee for patient care reviews
Participate in the Utilization Review Staff Committee, provide data, and contribute to internal process improvement
Provide staff education as needed to support utilization review goals
Meet review interval requirements and supply clinical information to obtain authorization
Respond to authorizing entities' requests for additional detail
Provide eligibility, benefits, and level-of-care criteria information to treatment teams and Patient Care Committees
Seek treatment information for authorization reviews and contribute to discharge planning
Participate in quality-of-care process improvement and identify and report QI triggers
Review patient eligibility and benefits and match level-of-care utilization
Ensure compliance with managed care behavioral health standards for utilization management procedures and documentation
Investigate and prepare insurance appeals related to medical necessity or treatment issues
Participate in ongoing utilization management and UR Staff Committee process improvement goals

Requirements

What you’ll need

Completed the basic professional curricula of a school of nursing approved and verified by a state board of nursing, with a diploma or degree, OR Master's degree in Social Work, Counseling, or a related behavioral health field
Valid multi-state or State of Oklahoma Registered Nurse License, or LCSW, LPC, or LMFT license
3–4 years of related experience in behavioral health care, including possible behavioral health managed care experience
Working knowledge of Microsoft Word, Excel, and Access
Effective interpersonal, written, and oral communication skills
Ability to analyze data to discover facts or develop knowledge, concepts, or interpretations
Ability to organize and prioritize work effectively and efficiently
Detail-oriented ability when examining numerical data
Ability to synthesize clinical case data into concise summaries

Benefits

Comp & perks

Part-time ECB status with a minimum number of worked hours per month as needed by the department
Limited benefit offerings