Utilization Management Coordinator (IDD)

Job Description

Job Description

We are seeking a Utilization Management (UM) Coordinator IDD to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Utilization Management (UM) Coordinator IDD plays a critical role in ensuring that individuals with intellectual and developmental disabilities receive timely, appropriate, and cost-effective healthcare services. The UM Coordinator is responsible for processing service authorizations, monitoring utilization trends, and collaborating with healthcare providers, families, and interdisciplinary teams to ensure care aligns with clinical and regulatory standards. This role includes both inbound and outbound communications, administrative support for precertification and prior authorization workflows, and a commitment to quality improvement and compliance. Through effective coordination and communication, the UM Coordinator helps improve outcomes for the IDD population while maintaining resource stewardship and service integrity.

Minimum Qualifications:

• High school diploma or GED required
• At least two years of experience in healthcare support role such as medical assistant, office assistant, or clinical administrative support
• Experience in utilization management, care coordination, or case management, particularly with Medicaid or Medicare populations
• Strong understanding of healthcare services and supports for individuals with intellectual and developmental disabilities
• Familiarity with managed care principles, prior authorization processes, and regulatory compliance
• Proficiency with electronic health records (EHR) systems, intake portals, and healthcare data systems
• Relevant experience may substitute for the educational requirement on a year-for-year basis

Preferred Qualifications:

• Associate’s or Bachelor’s degree in nursing, social work, health administration, public health, or a related field
• Certification in Utilization Review or Case Management (e.g., CPUR, CCM)
• Direct experience working with individuals with intellectual and developmental disabilities and their families
• Understanding of Medicaid waiver programs and community-based IDD services
• Experience working in a URAC and/or NCQA-compliant environment
• Bilingual proficiency (e.g., Spanish/English or Creole/English)

Responsibilities:

• Perform intake and screening of service requests from members, providers, and families via telephone, fax, and web portals, ensuring accurate triage and referral to clinical or medical staff as appropriate.
• Approve services not requiring medical review according to prior authorization guidelines, ensuring accurate documentation and compliance with regulatory standards.
• Communicate with healthcare providers and care managers, including outbound calls to obtain clinical information necessary for medical review and service authorization decisions.
• Maintain detailed and accurate records in internal systems to support regulatory compliance, risk management, and quality assurance efforts.
• Support the precertification and utilization management process, ensuring adherence to federal, state, and accreditation requirements, and participate in team quality improvement initiatives.