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Utilization Management Coordinator Jobs in California

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Utilization Management Coordinator information

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$15

$29

$46

How much do utilization management coordinator jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for utilization management coordinator in California is $29.22, according to ZipRecruiter salary data. Most workers in this role earn between $21.11 and $34.18 per hour, depending on experience, location, and employer.

What does a utilization management coordinator do?

A Utilization Management Coordinator is responsible for reviewing and assessing healthcare services to ensure that patients receive appropriate care while managing costs for healthcare providers or insurance companies. They evaluate medical records, coordinate with healthcare professionals, and help determine if certain treatments or procedures are medically necessary according to established guidelines. Their goal is to optimize the use of healthcare resources, prevent unnecessary treatments, and support quality patient outcomes.

What are the key skills and qualifications needed to thrive as a utilization management coordinator?

To thrive as a Utilization Management Coordinator, you need a background in healthcare or nursing, knowledge of medical terminology, and experience in case management or utilization review, often supported by a relevant degree or certification (such as RN or LPN). Familiarity with utilization management software, electronic health records (EHRs), and insurance authorization platforms is typically required. Strong organizational skills, attention to detail, and effective communication are essential soft skills for this role. These capabilities ensure accurate review of medical cases, compliance with regulations, and efficient coordination between providers, payers, and patients.

How does a utilization management coordinator typically collaborate with clinical staff and insurance providers?

A Utilization Management Coordinator serves as a vital link between healthcare providers, clinical staff, and insurance companies. They regularly communicate with physicians and nurses to gather clinical information, review treatment plans, and ensure that proposed services meet medical necessity criteria. Coordinators also interact with insurance providers to obtain pre-authorizations, clarify coverage policies, and appeal denied claims when appropriate. Effective collaboration and strong communication skills are essential, as the role requires balancing the needs of patients, providers, and payers while ensuring timely and cost-effective care.

What degree do you need for utilization management coordinator?

A utilization management coordinator typically needs at least a bachelor's degree in healthcare administration, nursing, or a related field. Relevant certifications, such as Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Strong knowledge of medical terminology, insurance processes, and data analysis tools is also important.

What are the most commonly searched types of Utilization Management jobs in California?

The most popular types of Utilization Management jobs in California are:

What are popular job titles related to Utilization Management Coordinator jobs in California?

For Utilization Management Coordinator jobs in California, the most frequently searched job titles are:

What job categories do people searching Utilization Management Coordinator jobs in California look for?

The top searched job categories for Utilization Management Coordinator jobs in California are:

What cities in California are hiring for Utilization Management Coordinator jobs?

Cities in California with the most Utilization Management Coordinator job openings:

Utilization Management Coordinator jobs near you
Infographic showing various Utilization Management Coordinator job openings in California as of August 2026, with employment types broken down into 1% As Needed, 87% Full Time, 10% Part Time, and 2% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $60,778 per year, or $29.2 per hour.

Utilization Management Coordinator I

North East Medical Services

Burlingame, CA • On-site

$38/hr

Full-time

Medical, Dental, Vision, Retirement

Posted 6 days ago

Job description

The Utilization Management Coordinator I functions under the direct supervision of a physician or Registered Nurse, performing utilization management (UM) and care coordination duties for the NEMS MSO.

ESSENTIAL JOB FUNCTIONS:
  • Review daily all incoming Referral Requests and Treatment Authorization Requests for inpatient and outpatient services.
  • Process and approve authorization requests according to the NEMS MSO Authorization Grid and to established clinical guidelines.
  • Must meet the quantitative productivity standard of 250 authorizations per week for the outpatient UM Coordinator and 115 authorizations per week for the inpatient UM Coordinator.
  • For complex cases, research additional relevant clinical guidelines from different sources.
  • Responsible to prepare and present complex cases to Medical Director for review; confirm Medical Director’s approval/modification/denial decision for record tracking.
  • Perform Care Coordination activities with members, families, specialists, and ancillary providers for authorized services.
  • Perform customer service for UM inquiries to Primary Care Physician, specialist, and members.
  • Stay current with DHCS regulations, Health Plan agreements, and Industry Standard guidelines applicable to healthcare programs.
  • Communicate UM related information and updates to all members of the health care team, patients, and their families.
  • Follow the appropriate turnaround timeframe for decisions and notification of members and providers.
  • Performs other job duties as required by manager/supervisor.

Qualifications:
  • Completion of a 2-year degree or higher.
  • Knowledge of medical terminology.
  • Completion of a recognized Medical Assistant degree or certificate a plus.
  • Excellent data entry skills.
  • Working knowledge of managed-care a plus.
  • Strong communication, analytical, and problem-solving skills.
  • Knowledge of community resources and cultural needs.
  • Good organization and prioritization skills, outstanding in time management.
  • Recent experience in a clinic or outpatient setting desirable; able to perform efficiently and appropriately in a busy environment.

LANGUAGE:
  • Must be able to fluently speak, read and write English.
  • Fluent in Chinese (Cantonese and/or Mandarin) preferred.
  • Fluent in other languages is an asset.

STATUS:
  • This is an FLSA Non-exempt position.
  • This is not an OSHA high-risk position.
  • This is a full-time position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).