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What does a utilization coordinator do?

Updated January 8, 2025
7 min read

Utilization coordinators are healthcare professionals who coordinate the effective use of health care services as well as review the medical care of inpatient hospitalizations. These coordinators are required to provide scheduling conflict information to their supervisors to alleviate any potential issues with the schedules of physicians that would interrupt patient care. They must provide information education to nursing and medical staff about the issues of utilization. Utilization coordinators must also perform clerical duties and utilize customized data entry programs to assist the claims department with data entry of claims.

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Utilization coordinator responsibilities

Here are examples of responsibilities from real utilization coordinator resumes:

  • Manage and coordinate authorization of denial letters and request for appeals with all levels of services.
  • Manage and coordinate the workload of the release team members and are responsible for organizing and hosting all production release windows.
  • Perform accurate verification of eligibility and benefits as well as advanced application of CPT, ICD-9 and ICD-10 codes.
  • Assign accurate ICD-9 and CPT codes to request services for referral and authorization processing.
  • Claim adjudication for assign HMO members.
  • Provide orientation to pre-certification process for HMO, PPO, and POS members.
  • Leverage excellent skills in ICD-9 and CPT-4 coding to submit healthcare claims and ensure efficient processing of reimbursements.
  • Monitor inpatient hospital stays consistent with Milliman & Roberts guidelines.
  • Collect all necessary documents to obtain Medicaid approval within HIPAA guidelines.
  • Coordinate multiple administrative and operational support functions focuse on appeals and subcommittee logistics.
  • Obtain insurance preauthorizations, help physicians determine appropriate admission status according to Milliman guidelines.
  • Conduct comprehensive interviews of doctors, patients and providers to establish case histories and gather appeal-relate documents and information.
  • Hold professional understanding of a caseload of patients' individualize treatment plans and clinical criteria through collaboration with treatment team.
  • Take ownership for full implementation of corporate programs and initiatives on merchandising, payroll management, productivity, and associate morale.
  • Process member utilization data into the IDX system, including return notification to providers of the authorization number.

Utilization coordinator skills and personality traits

We calculated that 17% of Utilization Coordinators are proficient in Patients, Utilization Management, and Patient Care. They’re also known for soft skills such as Detail oriented, Emotional stability, and Physical stamina.

We break down the percentage of Utilization Coordinators that have these skills listed on their resume here:

  • Patients, 17%

    Hold professional understanding of a caseload of patients' individualized treatment plans and clinical criteria through collaboration with treatment team.

  • Utilization Management, 11%

    Coordinate pharmaceutical utilization management program.

  • Patient Care, 8%

    Reviewed medical care of inpatient hospitalizations and assisted in setting up outpatient care for both adult and pediatric population.

  • Medical Terminology, 6%

    Maintained knowledge of medical terminology, anatomy and physiology, and medical coding and billing procedures utilizing proper insurance fee schedules.

  • Data Entry, 5%

    Performed data entry authorization for Intake Coordinators and staff.

  • Utilization Review, 5%

    Prepared authorization requests for Medical Director and Utilization Review Nurse to include any medical documents and benefits pertinent to authorization request.

Most utilization coordinators use their skills in "patients," "utilization management," and "patient care" to do their jobs. You can find more detail on essential utilization coordinator responsibilities here:

Detail oriented. One of the key soft skills for a utilization coordinator to have is detail oriented. You can see how this relates to what utilization coordinators do because "registered nurses must be precise because they must ensure that patients get the correct treatments and medicines at the right time." Additionally, a utilization coordinator resume shows how utilization coordinators use detail oriented: "oversee the compliance of regulations detailed in cms inpatient prospective payment system to prevent denial of claims. "

Emotional stability. Another essential skill to perform utilization coordinator duties is emotional stability. Utilization coordinators responsibilities require that "registered nurses need emotional resilience and the ability to cope with human suffering, emergencies, and other stressors." Utilization coordinators also use emotional stability in their role according to a real resume snippet: "provide emotional support, crisis interventions, and case management. "

Physical stamina. utilization coordinators are also known for physical stamina, which are critical to their duties. You can see how this skill relates to utilization coordinator responsibilities, because "nurses should be comfortable performing physical tasks, such as lifting patients." A utilization coordinator resume example shows how physical stamina is used in the workplace: "assisted patients and their families in the resolution of mental/physical disorders to help achieve their highest level of functioning. "

Organizational skills. A commonly-found skill in utilization coordinator job descriptions, "organizational skills" is essential to what utilization coordinators do. Utilization coordinator responsibilities rely on this skill because "nurses often work with multiple patients who have a variety of health needs." You can also see how utilization coordinator duties rely on organizational skills in this resume example: "coordinated physician to physician reviews and appeals processes to increase organizational efficiency. "

Communication skills. While "communication skills" is last on this skills list, don't underestimate its importance to utilization coordinator responsibilities. Much of what a utilization coordinator does relies on this skill, seeing as "registered nurses must be able to communicate effectively with patients in order to understand their concerns and evaluate their health conditions." Here is a resume example of how this skill is used in the everyday duties of utilization coordinators: "initiated ongoing communication with members of the treatment team in order to meet health care needs of patients and family members. "

All utilization coordinator skills

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Compare different utilization coordinators

Utilization coordinator vs. Surgery scheduler

A surgery scheduler is responsible for organizing medical information, coordinating with doctors and other health professionals, and reaching out to patients to inform them of scheduled medical procedures and appointments. Surgery schedulers perform clerical and administrative duties, such as processing patients' payments, verifying insurance details, and updating their account information on the database. They also monitor the adequacy of inventory for medical operations and create purchase requests as needed. A surgery scheduler must have excellent communication skills, especially in responding to patients' inquiries and concerns and resolving complaints.

We looked at the average utilization coordinator salary and compared it with the wages of a surgery scheduler. Generally speaking, surgery schedulers are paid $13,319 lower than utilization coordinators per year.Even though utilization coordinators and surgery schedulers are distinct careers, a few of the skills required for both jobs are similar. For example, both careers require patients, patient care, and medical terminology in the day-to-day roles and responsibilities.

There are some key differences in the responsibilities of each position. For example, utilization coordinator responsibilities require skills like "utilization management," "utilization review," "home health," and "discharge planning." Meanwhile a typical surgery scheduler has skills in areas such as "customer service," "surgical procedures," "surgery scheduling," and "anesthesia." This difference in skills reveals the differences in what each career does.

Surgery schedulers tend to make the most money working in the health care industry, where they earn an average salary of $34,302. In contrast, utilization coordinators make the biggest average salary, $51,729, in the construction industry.On average, surgery schedulers reach lower levels of education than utilization coordinators. Surgery schedulers are 8.9% less likely to earn a Master's Degree and 0.9% less likely to graduate with a Doctoral Degree.

Utilization coordinator vs. Scheduler

A scheduler is responsible for arranging appointments and carrying out reminder calls and correspondence to anyone involved. In a company setting, it is also a scheduler's responsibility to coordinate with various departments and personnel to organize an accurate timetable that will consist of meetings, gatherings, deadlines, or other pressing matters. Furthermore, a scheduler must have attention to detail as one must perform bookkeeping tasks, fix scheduling issues or conflicts, and organize documentation. There are also instances where one must process orders or payments.

On average, schedulers earn a $7,226 lower salary than utilization coordinators a year.While the salary may differ for these jobs, they share a few skills needed to perform their duties. Based on resume data, both utilization coordinators and schedulers have skills such as "patients," "patient care," and "medical terminology. "

While some skills are similar in these professions, other skills aren't so similar. For example, resumes show us that utilization coordinator responsibilities requires skills like "utilization management," "utilization review," "discharge planning," and "mental health." But a scheduler might use other skills in their typical duties, such as, "customer service," "phone calls," "patient appointments," and "strong customer service."

Schedulers may earn a lower salary than utilization coordinators, but schedulers earn the most pay in the construction industry with an average salary of $53,150. On the other hand, utilization coordinators receive higher pay in the construction industry, where they earn an average salary of $51,729.In general, schedulers achieve lower levels of education than utilization coordinators. They're 6.6% less likely to obtain a Master's Degree while being 0.9% less likely to earn a Doctoral Degree.

Utilization coordinator vs. Referral specialist

Referral specialists are responsible for ensuring patients are already cleared for specialty service office visits. They resolve registration, pre-certification, and case-related affairs before the client's appointment. Also, they give support to clinical staff to manage the administrative components of clinical referrals for many services. They must gather relevant information from financial counselors, insurance carriers, and other supplementary staff to make sure the patient's financial responsibility for services are provided. Additionally, they act as a liaison between the patients, physicians, hospitals, health insurance vendors, or other referral sources.

On average scale, referral specialists bring in lower salaries than utilization coordinators. In fact, they earn a $11,648 lower salary per year.By looking over several utilization coordinators and referral specialists resumes, we found that both roles require similar skills in their day-to-day duties, such as "patients," "patient care," and "medical terminology." But beyond that, the careers look very different.

There are many key differences between these two careers, including some of the skills required to perform responsibilities within each role. For example, a utilization coordinator is likely to be skilled in "utilization management," "utilization review," "discharge planning," and "appeals," while a typical referral specialist is skilled in "customer service," "pet," "primary care," and "process referrals."

Referral specialists earn the highest salary when working in the non profits industry, where they receive an average salary of $37,335. Comparatively, utilization coordinators have the highest earning potential in the construction industry, with an average salary of $51,729.When it comes to education, referral specialists tend to earn similar degree levels compared to utilization coordinators. In fact, they're 2.9% less likely to earn a Master's Degree, and 0.8% less likely to graduate with a Doctoral Degree.

Utilization coordinator vs. Unit secretary

Unit secretaries are administrative workers in a medical facility, usually a hospital or a clinic. They are in charge of religious activities in the unit or department they are assigned to. They manage incoming and outgoing mail, phone calls, and even appointments. They handle filing and recording of the documents of the department. They also take minutes of meetings and ensure that action plans are followed through. Unit secretaries should be familiar with the individuals in the department. They should also be accustomed to the schedule of members of the unit. Unit secretaries should be organized, dedicated, and trustworthy.

Unit secretaries average a lower salary than the annual salary of utilization coordinators. The difference is about $15,638 per year.While their salaries may vary, utilization coordinators and unit secretaries both use similar skills to perform their duties. Resumes from both professions include skills like "patients," "patient care," and "medical terminology. "While some skills are required in each professionacirc;euro;trade;s responsibilities, there are some differences to note. "utilization management," "utilization review," "discharge planning," and "mental health" are skills that commonly show up on utilization coordinator resumes. On the other hand, unit secretaries use skills like customer service, patient charts, physician orders, and phone calls on their resumes.In general, unit secretaries earn the most working in the health care industry, with an average salary of $31,531. The highest-paying industry for a utilization coordinator is the construction industry.The average resume of unit secretaries showed that they earn lower levels of education compared to utilization coordinators. So much so that theyacirc;euro;trade;re 7.1% less likely to earn a Master's Degree and less likely to earn a Doctoral Degree by 0.7%.

Types of utilization coordinator

Updated January 8, 2025

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

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