Utilization Management Coordinator Jobs
Utilization Management Coordinator jobs are open across health insurance, hospital systems, managed care, and physician groups, at every level from entry-level to senior and lead, with specializations in prior authorization, case review, and clinical appeals. Find a role that fits below and apply directly.
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Showing 5 of 170+ Utilization Management Coordinator jobs
50 West Town Street
Columbus, Ohio, 43215
United States
Investing in opportunities for Ohioans that work for every person and every family in every corner of our state is at the hallmark of Governor DeWine’s agenda for Ohio’s future. To ensure Ohio is “the best place to live, work, raise and family and start a business,” we must have strong schools, a great quality of life, and compassion for those who need our help.
Ohio Department of Medicaid plays a unique and necessary role in supporting the governor’s vision. As the single state Medicaid agency responsible for administering high-quality, person-centric healthcare, the department is committed to supporting the health and wellbeing of nearly one in every four Ohioans served. We do so by:
- Delivering a personalized care experience to more than three million people served.
- Improving care for children and adults with complex behavioral health needs.
- Working collectively with our partners and providers to measurably strengthen wellness and health outcomes.
- Streamlining administrative burdens so doctors and healthcare providers have more time for patient care.
- Ensuring financial transparency and operational accountability across all Medicaid programs and services.
Office: Health Innovation &Quality
Bureau: Clinical Operations
Classification: Medicaid Health Systems Specialist RN (PN: 20102136)
Job Overview:
As the Utilization Management (UM) Nurse in the Bureau of Clinical Operations, Ohio Department of Medicaid (ODM), your responsibilities will include:
- Reviews Clinical Coverage Policies (CCPs) of the managed care plans to ensure managed care coverage meets medical necessity, benefit coverage rules, and applicable Ohio Administrative Code standards.
- Conducts validation of pre and post services across all service categories Durable Medical Equipment (DME), inpatient/outpatient to meet required clinical criteria and documentation thresholds
- Assists with rules language by interpreting Fee for Service (FFS) rules against managed care impact and CCP requirements
- Verifies completeness, prior authorization and other submissions in alignment with UM policy requirements.
- Participates in cross-team collaboration with medical directors, reviewers, policy teams, and managed care leads to ensure UM consistency and alignment with statewide managed care requirements.
Compensation is as listed on the posting unless required by legislation or union contract.
Travel required, as needed. Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence.
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:
- Medical Coverage
- Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
- Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
- Childbirth, Adoption, and Foster Care leave
- Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
- Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation)
- Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.
- Or for positions other than those requiring valid license as registered nurse, completion of undergraduate core program in business administration, social or behavioral science, health or statistics additional 24 mos. exp. specific to subject area of which 12 mos. exp. in use of spreadsheet and database software. Note: education & experience to be commensurate with approved position description on file.
- Or for positions other than those requiring valid license as registered nurse, 24 months experience as Medicaid Health Systems Analyst, (65291) may be substituted for the experience required, but not for the mandated licensure.
- Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.
Job Skills: Nursing, Health Administration
Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.
50 West Town Street
Columbus, Ohio, 43215
United States
Investing in opportunities for Ohioans that work for every person and every family in every corner of our state is at the hallmark of Governor DeWine’s agenda for Ohio’s future. To ensure Ohio is “the best place to live, work, raise and family and start a business,” we must have strong schools, a great quality of life, and compassion for those who need our help.
Ohio Department of Medicaid plays a unique and necessary role in supporting the governor’s vision. As the single state Medicaid agency responsible for administering high-quality, person-centric healthcare, the department is committed to supporting the health and wellbeing of nearly one in every four Ohioans served. We do so by:
- Delivering a personalized care experience to more than three million people served.
- Improving care for children and adults with complex behavioral health needs.
- Working collectively with our partners and providers to measurably strengthen wellness and health outcomes.
- Streamlining administrative burdens so doctors and healthcare providers have more time for patient care.
- Ensuring financial transparency and operational accountability across all Medicaid programs and services.
Office: Health Innovation &Quality
Bureau: Clinical Operations
Classification: Medicaid Health Systems Specialist RN (PN: 20102136)
Job Overview:
As the Utilization Management (UM) Nurse in the Bureau of Clinical Operations, Ohio Department of Medicaid (ODM), your responsibilities will include:
- Reviews Clinical Coverage Policies (CCPs) of the managed care plans to ensure managed care coverage meets medical necessity, benefit coverage rules, and applicable Ohio Administrative Code standards.
- Conducts validation of pre and post services across all service categories Durable Medical Equipment (DME), inpatient/outpatient to meet required clinical criteria and documentation thresholds
- Assists with rules language by interpreting Fee for Service (FFS) rules against managed care impact and CCP requirements
- Verifies completeness, prior authorization and other submissions in alignment with UM policy requirements.
- Participates in cross-team collaboration with medical directors, reviewers, policy teams, and managed care leads to ensure UM consistency and alignment with statewide managed care requirements.
Compensation is as listed on the posting unless required by legislation or union contract.
Travel required, as needed. Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence.
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:
- Medical Coverage
- Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
- Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
- Childbirth, Adoption, and Foster Care leave
- Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
- Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation)
- Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.
- Or for positions other than those requiring valid license as registered nurse, completion of undergraduate core program in business administration, social or behavioral science, health or statistics additional 24 mos. exp. specific to subject area of which 12 mos. exp. in use of spreadsheet and database software. Note: education & experience to be commensurate with approved position description on file.
- Or for positions other than those requiring valid license as registered nurse, 24 months experience as Medicaid Health Systems Analyst, (65291) may be substituted for the experience required, but not for the mandated licensure.
- Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.
Job Skills: Nursing, Health Administration
Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.
Utilization Management Coordinator Jobs by Experience Level
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Find JobsUtilization Management Coordinator Job Market
Who's Hiring
Top Industries Hiring
- Insurance
- Healthcare & Medical Services
- Education
- Manufacturing
- Technology & Software
What Employers Look For
The qualifications that appear most often in utilization management coordinator jobs.
- Experience applying InterQual or Milliman criteria for medical necessity review
- Active RN, LPN, or other clinical licensure preferred or required
- Proficiency with utilization management or care management software platforms
- Knowledge of insurance benefits, claims processes, and coverage determination
- Strong written communication skills for denial letters and clinical documentation
- Certified Professional in Utilization Review (CPUR) or case management certification preferred
Tips for Your Utilization Management Coordinator Job Search
Tailor your resume to clinical criteria
Highlight your hands-on experience applying InterQual or Milliman criteria, documenting medical necessity determinations, and communicating with providers. Hiring managers want to see that you can work within specific clinical guidelines, not just that you have a healthcare background.
List your certifications prominently
Certifications like CPUR, CCM, or relevant RN and LPN licensure move your application to the top of shortlists. Place them above your work history so reviewers spot them before reading your experience, especially for roles that list them as required or preferred.
Apply early to roles that fit
Migrate Mate lists utilization management coordinator openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Target postings by payer versus provider
Payer-side roles at insurance companies focus heavily on benefits language and denial rationale, while provider-side roles emphasize interdisciplinary rounding and discharge planning. Adjust your resume bullets to reflect whichever environment matches each opening you're targeting.
Prepare for scenario-based interview questions
Interviewers commonly walk through a hypothetical denial case and ask how you'd document your rationale or handle a physician escalation. Practice stating your decision-making process out loud, referencing specific criteria sets and the appeals workflow you've used.
Negotiate for access to care management tools
When evaluating an offer, ask which utilization management platform the team uses and whether training is provided. Proficiency in systems like Jiva, Facets, or authorization portals directly affects your productivity and your value in the role long-term.
Utilization Management Coordinator Jobs: Frequently Asked Questions
Which companies are hiring the most utilization management coordinators?
CommunityCare, Optum, and UF Health are hiring the most utilization management coordinators right now, with openings concentrated in California, New York, and Florida, based on current listings on Migrate Mate as of November 2026. Health insurers and large hospital networks consistently post the highest volume of openings in this role.
How many utilization management coordinator jobs are remote?
About 77% of utilization management coordinator openings are fully remote or hybrid as of November 2026, reflecting strong demand for phone- and portal-based review work that doesn't require an on-site presence. Prior authorization and concurrent review roles tend to be the most remote-friendly, while discharge planning positions more often require facility access.
How do you become a utilization management coordinator?
Most utilization management coordinators start with a clinical background, typically as an RN, LPN, or medical coder, then move into the role by joining a health plan or hospital UM department. From there, learning to apply evidence-based criteria like InterQual or Milliman, gaining familiarity with payer portals, and pursuing a certification such as CPUR will position you for advancement.
Can you get hired as a utilization management coordinator with little experience?
Entry-level utilization management coordinator roles do exist, particularly at health insurers that hire clinical staff with strong documentation skills and train them on criteria application. If your background is in medical coding, claims, or nursing support rather than direct UM, emphasize any exposure to insurance authorization workflows, benefit language, or care coordination in your application materials.
What does the utilization management coordinator interview process look like?
The process typically includes a phone screen with HR, followed by a panel or one-on-one interview with a UM manager or clinical director. Expect scenario questions about denial rationale, provider communications, and how you handle disagreements with a physician recommendation. Some employers add a written exercise asking you to review a sample case and document a coverage decision using their criteria set.
Where can I find and apply to utilization management coordinator jobs?
You can find and apply to utilization management coordinator jobs on Migrate Mate, which lists current openings from across the United States. Find roles that match your experience and apply directly to each listing from the page.
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