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NeueHealth is a value-driven healthcare company committed to making high-quality, coordinated care accessible and affordable across the ACA Marketplace, Medicare, and Medicaid. The Lead Utilization Management (UM) Coordinator provides operational leadership and oversight for the UM Coordinator team while supporting the coordination, processing, and administrative functions of the utilization review process.
In this role, you will lead daily operations and workflow of the UM Coordinator team to ensure timely processing of authorization requests. You'll serve as the primary resource and subject matter expert for UM Coordinators, providing guidance, coaching, and support on complex cases and operational issues. Key responsibilities include assisting leadership with onboarding, training, mentoring, and ongoing development of new and existing UM Coordinators; monitoring team productivity, work queues, turnaround times, and workload distribution to ensure compliance with regulatory and organizational standards.
You will receive, review, and process incoming requests for authorization of medical services, coordinate with providers, members, and internal clinical staff to obtain required documentation, and enter authorization requests into the utilization management system accurately and efficiently. You'll track pending authorizations to ensure timely processing and communicate authorization determinations to providers and members within required regulatory timeframes.
Additional responsibilities include collaborating with UM nurses and physicians to facilitate medical necessity reviews, performing quality reviews of authorization documentation, assisting with audits and regulatory readiness activities, escalating complex issues to management, and acting as a liaison between internal departments, providers, health plans, and external vendors. You'll promote compliance with NCQA, CMS, state and federal regulations, and maintain strict adherence to HIPAA and confidentiality standards.
Required qualifications include a minimum of 3–5 years of experience in a health plan or managed care environment, at least 2 years of Utilization Management, Prior Authorization, or Case Management support experience, and bilingual proficiency (English/Spanish). Previous experience serving as a team lead, trainer, mentor, or in an informal leadership role is strongly preferred. You should have advanced knowledge of medical terminology, utilization management, prior authorization, and healthcare benefit processes, strong understanding of regulatory requirements, and proficiency with Microsoft Office Suite and UM platforms such as MCG or InterQual.
