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Utilization Coordinator
Location
MST (UTC-7)
Posted
9 days ago
Salary
$5 - $6 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Utilization Coordinator
Remote Raven
Role Description We are seeking a detail-oriented and experienced Utilization Coordinator to manage the insurance prior authorization process on a part-time, remote basis. This role is focused exclusively on authorization requests submitted via fax and payer portals — from initial clinical documentation gathering through submission, status tracking, and resolution. The Utilization Coordinator works at the intersection of clinical operations and insurance compliance. They are responsible for ensuring that authorization requests are submitted accurately, on time, and with the right clinical documentation — and for following the authorization through to approval, denial, or peer-to-peer review. This is a deadline-driven, detail-intensive role that requires someone who is organized, persistent, and familiar with the payer authorization landscape. Key Responsibilities - Authorization Request Submission - Review incoming authorization requests and identify all required clinical documentation for each payer and service type. - Submit prior authorization requests to insurance carriers via fax and payer portals within each payer's required timeframe. - Ensure all submitted requests are complete, accurate, and include the appropriate supporting clinical documentation to avoid unnecessary delays or denials. - Maintain working knowledge of payer-specific authorization requirements, submission methods, and timelines across all relevant insurance carriers. - Clinical Documentation Gathering - Coordinate with the clinical and medical teams to gather necessary documentation for authorization requests, including clinical notes, treatment plans, physician orders, and supporting records. - Follow up proactively with clinical staff when documentation is incomplete, missing, or requires additional detail to meet payer criteria. - Communicate clearly with internal teams about what is needed, why it is needed, and the urgency of the timeline. - Ensure all clinical documentation is organized, complete, and appropriately formatted before submission. - Authorization Status Tracking - Maintain an accurate and up-to-date tracking log of all submitted authorization requests, pending decisions, and authorization statuses. - Monitor payer portals and fax queues regularly for updates, approvals, denials, and requests for additional information. - Proactively follow up with payers on pending authorizations that are approaching deadlines or have not received timely responses. - Communicate authorization status updates to relevant internal stakeholders, including clinical and billing teams, as decisions are received. - Peer-to-Peer Review Coordination - Identify cases where a peer-to-peer review has been requested by the payer or may be beneficial following a denial. - Coordinate peer-to-peer review scheduling between the payer and the appropriate treating or ordering provider. - Prepare relevant clinical documentation and case summaries to support the provider in advance of the peer-to-peer call. - Follow up on peer-to-peer outcomes and ensure the resulting authorization decision is documented and acted upon appropriately. - Issue Resolution & Follow-Up - Identify and troubleshoot authorization delays, payer requests for additional information, and other barriers to timely approval. - Escalate complex denials, coverage disputes, or payer issues to the appropriate internal team member with thorough documentation. - Maintain a follow-up schedule for open authorization issues and ensure nothing is left unresolved or unmonitored. - Communicate resolution outcomes to clinical, billing, and operational stakeholders as appropriate. Qualifications - Prior experience in a utilization management, prior authorization, or insurance authorization role in a healthcare setting. - Solid understanding of the insurance prior authorization process including submission via fax and payer portals. - Familiarity with payer-specific authorization requirements and the ability to navigate multiple payer portals efficiently. - Experience coordinating with clinical teams to gather and organize medical documentation for authorization submissions. - Strong attention to detail and organizational skills — authorization requests must be accurate, complete, and submitted on time. - Comfortable managing a tracking system for multiple open authorization cases simultaneously. - Reliable and self-directed in a remote work environment — deadlines are firm and follow-up is expected without prompting. - Clear written and verbal communication skills for coordinating with clinical staff and internal stakeholders. Preferred Qualifications - Experience coordinating peer-to-peer reviews between payers and treating providers. - Familiarity with medical necessity criteria frameworks such as InterQual or MCG (Milliman Care Guidelines). - Background in behavioral health, specialty care, or a high-authorization-volume clinical setting. - Experience using electronic health record (EHR) systems and insurance payer portals for authorization management. - Knowledge of HIPAA regulations and proper handling of protected health information (PHI). Work Schedule - Part-time role (20 hours a week; 12 - 4 pm MST). - 100% Remote. - Rate is $5-$6/hr.
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Commonwealth of PennsylvaniaThe Commonwealth of Pennsylvania was the second American territory inducted into the United States in 1787, just five days after the induction of the state of D
Title: Education Administration Associate Location: Harrisburg United States Job Description: Education Administration Associate Salary $59,345.00 - $90,211.00 Annually Location Dauphin County, PA Job Type Civil Service Permanent Full-Time Job Number CS-2026-50884-22060 Department Department of Education Division Div Chld Adlt Cre Fd Prgm Opening Date 07/15/2026 Closing Date 7/28/2026 11:59 PM Eastern Job Code 22060 Position Number 00048414 Union FOSCEP Bargaining Unit C4 Pay Group ST07 Bureau / Division Code 00166710 Bureau / Division Food & Nutrition - Child and Adult Care Food Program Worksite Address 607 South Drive City Harrisburg, Pennsylvania Zip Code 17120 Contact Name Shawna Handley Contact Phone 717.783.4911 Contact Email shandley@pa.gov - Description - Benefits - Questions THE POSITION Are you eager to begin a new chapter in your career? 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Noadditionalexam is required at a test center (also referred to as a written exam). - Your score is based on the detailed information you provide on your application and in response to the supplemental questions.? - Your score is valid for this specific posting only. - You must provide complete andaccurateinformation or: - your score may be lower than deserved. - you may be disqualified. - You may only apply/test?once?for this posting. - Your results will be provided via email. Learn more about our Total Rewards by watching this short video! See the total value of your benefits package by exploring our benefits calculator. Health & Wellness We offer multiple health plans so our employees can choose what works best for themselves and their families. Our comprehensive benefits package includes health coverage, vision, dental, and wellness programs.* Compensation & Financial Planning We invest in our employees by providing competitive wages and encouraging financial wellness by offering multiple ways to save money and ensure peace of mind including multiple retirement and investment plan options. Work/Life Balance We know there's more to life than just work! Our generous paid leave benefits include paid vacation, paid sick leave, eight weeks of paid parental leave, military leave, and paid time off for most major U.S. holidays, as well as flexible work schedules and work-from-home opportunities.* Values and Culture We believe in the work we do and provide continual opportunities for our employees to grow and contribute to the greater good. As one of the largest employers in the state, we provide opportunities for internal mobility, professional development, and the opportunity to give back by participating in workplace charitable giving. Employee Perks Sometimes, it is the little "extras" that make a big difference. Our employees receive special employee-only discounts and rates on a variety of services and memberships. For more information on all of these Total Rewards benefits, please visit www.employment.pa.gov and click on the benefits box. - Eligibility rules apply. 01 How many years of full-time professional experience in education or educational administration do you possess? - 2 years or more - 1 but less than 2 years - Less than 1 year - None 02 If you are claiming experience in the above question, please list the employer(s) where you gained this experience in the text box below. The employer(s) and a description of the experience must also be included in the appropriate sections of your application if you would like the experience to be considered in the eligibility decision. If you claimed you do not have experience, type N/A in the text box below. 03 How much graduate coursework in education have you completed? If you are claiming credits/degree, you must upload a copy of your college transcript(s) for this education to be considered in the eligibility decision. Unofficial transcripts are acceptable. You must attach your transcript(s) prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a transcript(s) to the application after it has been submitted. If your education was acquired outside of the United States, you must upload a copy of your foreign credential evaluation report. We can only accept foreign credential evaluations from organizations that are members of the National Association of Credential Services (NACES). A list of current NACES members can be found by visiting www.naces.org and clicking the Evaluation Services Link. You must attach your documentation prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a document to the application after it has been submitted. - 30 credits or more - Less than 30 credits - None 04 How much graduate coursework in educational, public, or business administration have you completed? If you are claiming credits/degree, you must upload a copy of your college transcript(s) for this education to be considered in the eligibility decision. Unofficial transcripts are acceptable. You must attach your transcript(s) prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a transcript(s) to the application after it has been submitted. If your education was acquired outside of the United States, you must upload a copy of your foreign credential evaluation report. We can only accept foreign credential evaluations from organizations that are members of the National Association of Credential Services (NACES). A list of current NACES members can be found by visiting www.naces.org and clicking the Evaluation Services Link. You must attach your documentation prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a document to the application after it has been submitted. - 30 credits or more - Less than 30 credits - None 05 You must complete the supplemental questions below. These supplemental questions are the exam and will be scored. They are designed to give you the opportunity to relate your experience and training background to the major activities (Work Behaviors) performed in this position. Failure to provide complete and accurate information may delay the processing of your application, or result in a lower-than-deserved score or disqualification. You must complete the application and answer the supplemental questions. Resumes, cover letters, and similar documents will not be reviewed for the purposes of determining your eligibility for the position or to determine your score. All information you provide on your application and supplemental questions is subject to verification. Any misrepresentation, falsification or omission of material facts is subject to penalty. If requested, you must provide documentation, including names, addresses, and telephone numbers of individuals who can verify the validity of the information you provide in the application and supplemental questions. Read each work behavior carefully. Determine and select which "Level of Performance" most closely represents your highest level of experience/training. List the employer(s)/training source(s) from your Work or Education sections of the application where you gained this experience/training. The "Level of Performance" you choose for each work behavior must be clearly supported within the description of the experience and training information entered in your application or your score may be lowered. In order to receive credit for experience, you must have worked in a job for at least six months in which the experience claimed was a major function. If you have read and understand these instructions, please click on the "Yes" button and proceed to the exam questions. If you have general questions regarding the application and hiring process, please refer to our FAQ page. - Yes 06 WORK BEHAVIOR 1- PROVIDES CONSULTATION AND TECHNICAL ASSISTANCE Provides technical guidance and consultation to staff, officials, and representatives of child nutrition programs on issues related to USDA food programs, helping them comply with federal requirements. Levels of Performance Select the "Level of Performance" which best describes your claim. - A. I have experience providing technical guidance and consultation to staff, officials, or representatives of CHILD NUTRITION PROGRAMS on issues related to USDA food programs. - B. I have experience providing technical guidance and consultation to staff, officials, or representatives of NUTRITION PROGRAMS concerning issues related to USDA food programs - C. I have experience providing technical guidance and consultation to staff, officials, or program representatives concerning program issues other than nutrition or USDA food programs. - D. I have successfully completed college-level coursework related to communication or public relations. - E. I have no experience or training related to this work behavior. 07 In the text box below, please describe your experience as it relates to the level of performance you claimed in this work behavior. Please be sure your response addresses the items listed below which relate to your claim. If you indicated you have no work experience related to this work behavior, type N/A in the box below. - The name(s) of the employer(s)/institution(s) where you gained this experience - The type(s) of programs where you provided technical guidance and consultation - The actual duties you performed - Your level of responsibility 08 If you have selected the level of performance pertaining to college coursework, please provide your responses to the items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below. - College/University - Course Title - Credits/Clock Hours 09 WORK BEHAVIOR 2 - TRAINING Develops and delivers training and workshops on implementation, compliance, and operational topics for all stakeholders of child nutrition programs, supporting effective and efficient program operations. Levels of Performance Select the "Level of Performance" which best describes your claim. - A. I have experience developing AND delivering training and workshops on implementation, compliance, and operational topics for all stakeholders of child nutrition programs. - B. I have experience developing OR delivering training and workshops on implementation, compliance, and operational topics for all stakeholders of child nutrition programs. - C. I have experience developing or delivering training materials. This training was NOT related to child nutrition programs. - D. I have successfully completed college-level coursework related to adult learning or training. - E. I have no experience or training related to this work behavior. 10 In the text box below, please describe your experience as it relates to the level of performance you claimed in this work behavior. Please be sure your response addresses the items listed below which relate to your claim. If you indicated you have no work experience related to this work behavior, type N/A in the box below. - The name(s) of the employer(s)/institution(s) where you gained this experience - Your experience providing training or developing training materials - The topic(s) of the training and the audience - Your level of responsibility 11 If you have selected the level of performance pertaining to college coursework, please provide your responses to the items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below. - College/University - Course Title - Credits/Clock Hours 12 WORK BEHAVIOR 3 - UPDATES POLICY AND PROCEDURES Develops and implements updates to policies, guidance, and procedures related to child nutrition programs to ensure consistent and compliant program implementation across Pennsylvania. Levels of Performance Select the "Level of Performance" which best describes your claim. - A. I have experience developing and implementing updates to policies, guidance, and procedures related to child nutrition programs. - B. I have experience developing OR implementing updates to policies, guidance, and procedures related to child nutrition programs. - C. I have experience developing OR implementing updates to policies or procedures. This was NOT related to child nutrition programs. - D. I have successfully completed college-level coursework related to policy development. - E. I have no experience or training related to this work behavior. 13 In the text box below, please describe your experience as it relates to the level of performance you claimed in this work behavior. Please be sure your response addresses the items listed below which relate to your claim. If you indicated you have no work experience related to this work behavior, type N/A in the box below. - The name(s) of the employer(s)/institution(s) where you gained this experience - Your experience developing or implementing updates to policies or procedures - Your experience making recommendations for policy and the type(s) - Your level of responsibility 14 If you have selected the level of performance pertaining to college coursework, please provide your responses to the items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below. - College/University - Course Title - Credits/Clock Hours 15 WORK BEHAVIOR 4 REVIEW AND ANALYZE DATA</p> Review and analyze program data to identify trends, potential non-compliance, and threats to program integrity. Compiles and evaluates reports to assess program quality and recommends opportunities for improvement. Levels of Performance Select the "Level of Performance" which best describes your claim. - A. I have experience reviewing AND analyzing program data to identify trends, potential non-compliance, and threats to program integrity. I have experience compiling and evaluating reports to assess program quality; and recommending opportunities for improvement. - B. I have experience reviewing AND analyzing program data to identify trends, potential non-compliance, and threats to program integrity. I have experience compiling and evaluating reports to assess program quality. Someone else recommended opportunities for improvement. - C. I have experience reviewing AND analyzing program data to identify trends, potential non-compliance, and threats to program integrity. - D. I have experience reviewing OR analyzing program data to identify trends, potential non-compliance, and threats to program integrity. - E. I have successfully completed college-level coursework related to technical analysis and quality assurance, compliance, or auditing. - F. I have no experience or training related to this work behavior. 16 In the text box below, please describe your experience as it relates to the level of performance you claimed in this work behavior. Please be sure your response addresses the items listed below which relate to your claim. If you indicated you have no work experience related to this work behavior, type N/A in the box below. - The name(s) of the employer(s)/institution(s) where you gained this experience - Your experience identifying trends, non-compliance, and program integrity - Your experience assessing program quality and recommending improvements - Your level of responsibility 17 If you have selected the level of performance pertaining to college coursework, please provide your responses to the items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below. - College/University - Course Title - Credits/Clock Hours


