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Utilization Management Support Coordinator Career Guide

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

A utilization management support coordinator is also responsible for looking at processes and policies in a healthcare facility and recommending changes to make sure things run smoothly and efficiently. In this role, you’ll stay on top of changes in federal and state healthcare laws to ensure the healthcare facility complies with those changes. A utilization management support coordinator works alongside healthcare managers to create and enact solutions to guarantee 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 will include 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 and we would love to hear from you!

Typical duties and responsibilities

  • Monitor the health and status of residents and patients within a facility to ensure that they are receiving proper care
  • 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 healthcare facility
  • Make recommendations on how the nursing service department can be improved
  • Monitor changes in federal and state healthcare laws and ensure compliance

Education and experience

  • Bachelor’s degree in social work, psychology, counseling, or a closely related field required
  • An associate’s or bachelor’s degree in nursing and a passing score on the NCLEX-RN licensing exam is often required as well

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 through Friday, 9 AM to 5 PM, but may vary depending on the needs of the company.

Typical hours

Many utilization management support coordinators typically work from 9 AM to 5 PM, Monday through Friday, in an office setting. However, those who work in facilities that run 24 hours a day could work varying shifts.

Available certifications

Although no certifications are required to become a utilization management support coordinator, going above and beyond will showcase to your employer that you are willing to put in the extra effort. Here is an option:

  • 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’s or bachelor’s degree in nursing and a license to practice nursing is also required. Depending on the type of facility to which you’re applying, work experience in the field is 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 healthcare facilities. A utilization management support coordinator needs to be familiar with the processes for receiving these accreditations, as they will play a crucial part in obtaining and maintaining them for their employer. Utilization management professionals can also earn personal certifications in the field, such as the Health Care Quality & Management (HCQM) Certification from the American Board of Quality Assurance and the 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 processes and making patient care more efficient, this field 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 healthcare facility, and they are responsible for deciding 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.