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Utilization Management Coordinator Jobs in Tennessee

Covenant Health

RN UTILIZATION MGMT I

Knoxville, TN · On-site

Collaborates with patient account services, physicians, care coordinators, physician advisors and facility departments as related to utilization management. Communicates with hospital and payor ...

Covenant Health

RN UTILIZATION MGMT I

Knoxville, TN · On-site

Collaborates with patient account services, physicians, care coordinators, physician advisors and facility departments as related to utilization management. Communicates with hospital and payor ...

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How much do utilization management coordinator jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for utilization management coordinator in Tennessee is $26.87, according to ZipRecruiter salary data. Most workers in this role earn between $19.42 and $31.39 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 Tennessee?

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

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

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

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

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

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

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

Utilization Management Coordinator jobs near you
Infographic showing various Utilization Management Coordinator job openings in Tennessee 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 $55,895 per year, or $26.9 per hour.

RN UTILIZATION MGMT I

Covenant Health

Knoxville, TN • On-site

Full-time

Posted 19 days ago

Job description

Overview
Registered Nurse Utilization Management
Full Time, 80 Hours Per Pay Period, Day Shift
Covenant Health Overview:
Covenant Health is the region's top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area's fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area's largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes "Best Employer" seven times.
Position Summary:
The RN Utilization Management I will perform utilization management functions to include medical necessity reviews to promote a utilization management program that operates 24 hours a day 7 days a week. Exhibits extraordinary leadership and professionalism in role. Prepares and reviews necessary documentation for insurance utilization management processes and coordinates communication between members of the UM team to ensure timely follow through for status placement. Collaborates with attending physician if ambiguous documentation pertaining to patient status placement requires clarification. Utilizes electronic utilization management database for documentation of interventions and communications so as to ensure accurate reporting. Collaborates with patient account services, physicians, care coordinators, physician advisors and facility departments as related to utilization management. Communicates with hospital and payor medical directors in order to correctly determine the medical necessity of patient status with a patient advocacy focus.
Responsibilities
  • Reviews precertification requests for medical necessity for all payors as applicable, referring to the second level physician reviewer those that require additional expertise.
  • Maintains accurate records of all communications and interventions related to utilization management.
  • Exhibits effective verbal and written communication skills in order to clearly present clinical and financial data to various audiences as necessary.
  • Collaborates with UM Committee when applicable.
  • Collaborates with payor utilization management liaisons and medical directors as applicable.
  • Establishes effective rapport with other employees, professional support service staff, payors, patients, families and physicians.
  • Intervenes in Peer-to-Peer meetings between physicians and payors as applicable.
  • Completes daily work lists for utilization review meeting the time frames set forth by Covenant Health.
  • Uses effective relationship management, coordination of services, resource management, education, patient advocacy and related interventions to:
    • Promote patient advocacy
    • Promote quality of care and/or life
    • Promote cost effective medical outcomes
    • Promote appropriate admission status
    • Provide continuity of care between utilization management and care coordinators
  • Coordinates/facilitates execution of notices (denials) of non-coverage when appropriate and communicates with key stakeholders to ensure that patient liability is correctly managed.
  • Exhibits expertise in utilization management including but not limited to:
    • Knowing Medicare rules and regulations related to utilization
    • Knowing payor policies related to utilization management
    • Knowing Covenant Health's Policies related to utilization management.
    • Keeping abreast of current changes affecting utilization management as applicable.
  • Performs well on internal audits thus promoting a culture of professional expertise in utilization management.
  • Provides monitoring and oversight of non-clinical utilization staff activities.
  • Provides advice and counsel to non-clinical precertification staff.
  • Assists with delayed claims review to determine appropriate number of observation hours as applicable in order for correct charges to be added to the patient's account.
  • Assist with insurance requested audits and provides information to supervisor related to inaccurate and/or missing documentation as applicable.
  • Attends meetings as required and participates on committees as directed.
  • Performs other related duties as assigned or requested.
  • Motivates coworkers and promotes a team effort in accomplishing goals and deadlines with accuracy, dependability and professionalism.
  • Supports, models and adheres to desired behaviors of the KBOS Constitution for caring which are; build a trusting environment by listening with an open mind and valuing different opinions; asking questions for understanding and allowing others to speak openly, do not gossip or criticize people behind their back, resolve conflicts, notice and express appreciation for good work and respect differences by listening with an open mind.
  • Supports, models and adheres to the desired behaviors of the KBOS Constitution and Covenant Health for service which are; take ownership for our mistakes, resolve customer problems on the spot whenever possible, treat all people with respect and kindness, strive to meet or exceed customer expectations, collect and use customer feedback/data to improve processes and service and set an example for accountability and responsiveness: return e-mail and phone calls promptly, assure deadlines are met, keep commitments.
  • Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives and participates in quality improvement initiatives as requested.
  • Performs other duties as assigned.

Qualifications
Minimum Education:
None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.
Minimum Experience:
Three (3) years of acute care nursing experience; a minimum of two (2) years of experience in area of assigned responsibility. Prefer recent utilization management or case management experience.
Licensure Requirement:
Current licensure as a Registered Nurse (RN) as issued by the State of Tennessee. CCM/CPHQ certification preferred or equivalent expertise in area of Utilization Management as evidenced by performance.

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