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How to Become an Utilization Management Support Coordinator

Do you like making sure systems run smoothly, and people are taken care of properly? In a position as a utilization management support coordinator, you can combine attention to detail with a passion for patient care. A utilization management support coordinator keeps track of the status of patients or residents within a health care facility and makes sure they are getting proper care. Also, they make sure employees in the facility have the right training to deliver appropriate care.

A utilization management support coordinator also looks at processes and policies in a health care facility and recommends changes to make it run smoothly and efficiently. In this position, you’ll also stay on top of changes in federal and state health care laws to make sure the health care facility complies with those changes. A utilization management support coordinator works alongside health care managers to create and enact solutions to ensure patient safety and quality of service.

Sample job description

The utilization management support coordinator is responsible for providing support to the utilization management (UM) process. This includes assisting with reviews of medical necessity and appropriateness, providing education to members and providers, and working with internal and external stakeholders to ensure quality care. The incumbent will also develop and maintain tools and resources to support UM activities. [Your Company Name] is hiring experienced utilization management support coordinators to join our growing company.

Typical duties and responsibilities

  • Monitor the health and status of residents or patients within a facility to ensure that they are being cared for properly
  • Train employees within the hospital to develop the right care plan
  • Perform administrative duties such as monitoring the discharge process and ensuring that clinical documentation is done accurately
  • Participate in inspections of the health care facility
  • Make recommendations on how the nursing service department can be improved
  • Monitor changes in federal and state health care laws, and ensure compliance

Education and experience

This position requires a bachelor’s degree in social work, psychology, counseling, or a closely related field. In most cases, an associate or bachelor’s degree in nursing, and a passing score on the NCLEX-RN licensing exam, are required.

Required skills and qualifications

  • Strong project management skills
  • Excellent presentation and communication skills
  • Robust assessment, analytical, and computer skills

Preferred qualifications

  • Develop and maintain tools and resources to facilitate the UM process
  • Provide education on the UM process, coverage, coding requirements, and medical necessity to members and providers
  • Assist with reviews of medical necessity and appropriateness
  • Work with internal and external stakeholders to ensure quality care

Typical work environment

The utilization management support coordinator will work in a call center or office environment. They will need to be able to work independently and have excellent communication skills. Hours are typically Monday-Friday 9am-5pm, but may vary depending on the needs of the company.

Typical hours

Many Utilization Management Support Coordinators work from 9 a.m. to 5 p.m. Monday through Friday in an office setting. However, some who work in facilities that run 24 hours a day could work other shifts.

Available certifications

Though no certifications are required to become a utilization management support coordinator, going above and beyond will showcase to your employee that you are willing to put in extra effort.

  • Health Utilization Management Certification. This is a certification in utilization management through the Utilization Review Accreditation Commission (URAC). Whether you are performing delegated or other review services, this certification validates your program approach as well as the inherent value you bring to your partner organization.

Career path

A bachelor’s degree in psychology, counseling, social work, or a related field is required for utilization management support coordinator positions. Sometimes, an associate or bachelor’s degree in nursing and a license to practice nursing is required. Depending on the type of facility to which you’re applying, work experience in that field is also preferred. Because utilization management support coordinators work on streamlining health care processes and making them more efficient, experience, and in-depth knowledge of those processes, as well as best practices regarding patient care, are also recommended.

The National Committee for Quality Assurance (NCQA) offers facilities accreditation in Utilization Management. URAC, formerly known as the Utilization Review Accreditation Commission, is a nonprofit organization that also offers utilization management accreditation to health care facilities. A utilization management support coordinator needs to be familiar with the processes for receiving these accreditations, as they will be a crucial part of obtaining and maintaining it for their employer. Utilization management professionals can also earn personal certifications in the field, such as Health Care Quality & Management (HCQM) Certification from the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP).

US, Bureau of Labor Statistics’ job outlook

SOC Code: 11-9111

2020 Employment429,800
Projected Employment in 2030569,400
Projected 2020-2030 Percentage Shift 32% increase
Projected 2020-2030 Numeric Shift139,600 increase

Since utilization management involves reviewing and making processes and patient care more efficient, it is always evolving. Industry analysts and thought leaders say one particular trend in the field that utilization management support coordinators should be aware of is the increasing role of the physician advisor. Physician advisors are doctors who can work inside or outside a health care facility, and they help decide whether specific procedures and services are medically necessary. Utilization management professionals have to work closely with physician advisors to coordinate patient care procedures.

Another trend in the utilization management field is the use of artificial intelligence (AI). Utilization management support coordinators are now using advanced analytics in their jobs. They’re looking at data regarding a patient’s entire medical history to tailor care plans to their specific cases and needs.