Utilization Management Coordinator {166725}

Title: Long Term Care Coordinator (Remote)

Location: Remote (California residents strongly preferred)

Schedule: Monday–Friday, 8:00 AM–5:00 PM (PT)

Pay: $40/hr

We’re hiring a Long Term Care Coordinator to support clinical staff with the administrative and non-clinical coordination work that keeps long-term care (LTC) admissions, transitions, and authorizations moving. This role focuses on tracking authorizations, ensuring required documentation is received on time, coordinating supportive services, and communicating with facilities, providers, and vendors. If you have experience in managed care, utilization review support, skilled nursing (SNF/LTC), discharge planning coordination, or Medi-Cal/Medicare-related workflows, this Long Term Care Coordinator role is a strong match.

• Coordinate and process Long Term Care admissions and transitions of care across the continuum
• Track, prioritize, and monitor authorizations and ensure documentation is received timely and accurately
• Coordinate supportive services including DME, transportation, and therapies
• Issue member/provider notifications via mail, fax, electronic media, and phone
• Partner with hospitals, SNFs, delegated groups, vendors, and providers to facilitate communication and care coordination
• Use established Title 22 long-term care guideline pathways for screening and authorization (including bed holds and leave of absence requests)
• Run scheduled and ad hoc utilization reporting , including “hold” status authorizations and trend identification
• Support resolution of inquiries/issues tied to claims, authorizations, appeals, eligibility , and preliminary processing of complaints/grievances
• Interpret and communicate member benefits ; support eligibility verification and issue resolution
• Perform high-volume documentation, data entry, and follow-up across multiple systems

• Experience in a managed care or healthcare setting (LTC/SNF experience strongly preferred)
• Experience with Medi-Cal and Medicare populations and related requirements
• Knowledge of DMHC regulations and DHCS contractual requirements preferred
• Background supporting utilization review , skilled nursing services, home health, discharge planning, behavioral health, or community resources is a plus
• Strong written/verbal communication, organization, and multi-tasking skills
• Proficiency with Microsoft Office and working across multiple platforms/systems
• Active driver’s license + auto insurance required

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