Utilization Management Support Specialist II

Sutter Health

. Accumulate, process, interpret, and document payer information to justify acute hospital admission, continued stay, and appropriate level-of-care billing .

Posted 9/15/2026full-timeRemote • California • United StatesJunior💰 $30 - $45 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical terminology, payer reimbursement plans, and revenue cycle processes while effectively managing appeals and denials. Strong ability to communicate, collaborate, and adhere to regulatory requirements to support optimal patient care.

Highest-signal resume keywords

Medical TerminologyPayer Reimbursement PlansRevenue Cycle ProcessesElectronic Health RecordsWritten And Verbal Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Insurance VerificationPayer Information ProcessingAppeal And Denial ManagementData Tracking And TrendingUtilization Management Operations

Soft Skills

Time ManagementOrganizational SkillsProblem SolvingTeam CollaborationRelationship Building

Tools & Technologies

Electronic Health RecordsComputer Applications

Industry Keywords

Acute Hospital AdmissionLevel-Of-Care BillingRegulatory CompliancePatient CareClinical Utilization Management

About the role

Key responsibilities & impact

Accumulate, process, interpret, and document payer information to justify acute hospital admission, continued stay, and appropriate level-of-care billing
Process concurrent and retrospective denials in collaboration with clinical utilization management staff and internal physician advisors
Develop, coordinate, and monitor appeal and denial process systems under management direction
Track and trend data
Coordinate utilization management operations with leadership and key stakeholders
Liaise with leadership, external payers, staff, and related departments
Troubleshoot, track, and trend level-of-service and payer behavior issues
Identify opportunities for improvement
Assist with assigned projects and participate in department meetings and team discussions
Adhere to privacy, safety, and regulatory requirements while supporting optimal patient care

Requirements

What you’ll need

HS Diploma or General Education Diploma (GED), or equivalent experience accepted in lieu of the required degree or diploma
1 year of recent relevant experience
Working knowledge of medical terminology
Experience with medical insurance verification and payer reimbursement plans
Knowledge of revenue cycle processes and criteria required for payment processes
Demonstrated knowledge of electronic health records and computer applications
Written and verbal communication skills
Time management and organizational skills
Ability to prioritize assignments and meet deadlines, production, and quality standards
Ability to work independently and as part of a team
Ability to identify, evaluate, and solve problems using established options
Ability to build collaborative relationships with internal and external customers
Ability to work rotating weekends
Ability to comply with local, state, and federal regulations, codes of conduct, policies, and procedures

Benefits

Comp & perks

Comprehensive benefits package for eligible positions
Total rewards program
Regular employee status
Full-time schedule with 40 weekly hours