Utilization Review Coordinator

CHS Career Site; United States; On-site; USD 52,000 - 72,000; Full time

Job summary

CHS Career Site is seeking an Utilization Review Coordinator in Franklin, TN. You will manage utilization review processes, collaborate with payers and hospital staff, and secure timely authorizations for admissions and extended stays.

You will monitor and document all authorization activities, assist with process improvements, and serve as a key liaison to reduce denials and optimize patient outcomes.

Qualifications

• Knowledge of utilization management principles, payer requirements, and healthcare regulations.
• Proficiency in case management systems and documentation tools.
• Strong communication and interpersonal skills with payers, clinicians, and staff.
• Critical thinking and problem-solving for authorization and denial issues.
• Excellent organizational skills to manage multiple priorities and deadlines.

Responsibilities

• Submits initial assessments and documentation to establish medical necessity.
• Communicates with payers to secure timely authorizations and reduce denials.
• Monitors and updates case management software with all authorizations and interactions.
• Coordinates Peer-to-Peer discussions for unresolved denials and documents outcomes.
• Closes cases after discharge with complete documentation for billing and audits.
• Maintains KPIs for the Utilization Review Service Line.
• Serves as a liaison to resolve issues with facility and payer representatives.
• Participates in training and onboarding within the department.

Skills

Utilization management

Payer requirements

Communication

Organization

Attention to detail

Training teammates

Education

H.S. Diploma or GED

Bachelor's Degree

Tools

Case management systems

Job description

Job Summary

The Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals activities. This role collaborates with payers, hospital staff, and clinical specialists to secure timely authorizations for hospital admissions and extended stays. The Utilization Review Coordinator monitors and documents all authorization activities, assists with process improvement initiatives, and serves as a key liaison to reduce denials and optimize patient outcomes.

Essential Functions

• Submits initial assessments, continued stay reviews, and payer-requested documentation, ensuring compliance with policies, regulations, and payer requirements to establish medical necessity.
• Communicates with commercial payers to provide concise and accurate information to secure timely authorizations and reduce potential denials, utilizing input from the Utilization Review Clinical Specialist.
• Monitors and updates case management software with documentation of escalations, avoidable days, authorization numbers, denials, and payer interactions to ensure accurate records.
• Coordinates Peer-to-Peer discussions for unresolved concurrent denials, ensuring the process aligns with hospital, corporate, and payer requirements. Documents outcomes in case management systems.
• Reviews and closes out cases after patient discharge, ensuring all required documentation is complete and understandable for billing and future audits. Places cases on hold as necessary to resolve pending authorizations or reviews.
• Maintains performance metrics aligned with Key Performance Indicators (KPIs) for the Utilization Review Service Line.
• Serves as a key contact for facility and payer representatives, fostering effective communication and collaboration to resolve issues promptly.
• Participates in training initiatives within the department, supporting onboarding and skill development for team members.
• Responds promptly to phone calls, faxes, and insurance portal requests, providing high standards of customer service and satisfaction.
• Escalates issues to the manager as appropriate and provides recommendations for improving operational efficiency and outcomes.
• Ensures accurate and timely communication of hospital stay authorizations, denials, and delays to all relevant stakeholders.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Qualifications

• H.S. Diploma or GED required
• Bachelor's Degree preferred
• 0-2 years of work experience in utilization review, hospital admissions or registration required
• 1-3 years of work experience in an office, processing center, or similar environment preferred

Knowledge, Skills and Abilities

• Strong knowledge of utilization management principles, payer requirements, and healthcare regulations.
• Proficiency in case management systems and technology resources for authorization tracking and documentation.
• Excellent communication and interpersonal skills to interact effectively with payers, clinicians, and administrative staff.
• Critical thinking and problem-solving skills to analyze and resolve authorization and denial issues.
• Strong organizational skills to manage multiple priorities and meet deadlines.
• Attention to detail for accurate documentation and process adherence.
• Ability to train and support team members, fostering a collaborative and productive environment.

Job Info

• Job Identification 154229
• Job Category Administrative Support
• Posting Date 06/08/2026, 02:07 PM
• Job Schedule Full time
• Job Shift Day
• Locations 4000 Meridian Blvd, Franklin, TN, 37067, US