Utilization Management Coordinator

Location: Bloomfield Hills, MI

Department: Utilization Management

Type: Full Time

Min. Experience: Mid Level


Integra Partners is a leading, tech-enabled, healthcare benefit management company focused on community-based care. Integra has a core competency in Durable Medical Equipment (DME), Orthotics and Prosthetics (O&P), and works with providers and health plans to facilitate care for hundreds of thousands of patients each year.  We have experienced rapid growth with no slowdown in sight.

Our leadership team is amazing and focused on what really matters to our business - every employee, every experience, and every customer. With the right people, success is unbounded. This is a truly unique opportunity to take a position with a great company, surrounded by an awesome team.

In 2015, Integra’s management and Tufts Health Plan of Massachusetts acquired the business. Tufts Health Plan is one of the country’s leading, 5-star, private health plans providing healthcare to individuals and employer groups. Integra now operates as a separate financial investment and subsidiary of Tufts Health Plan with a separate board of directors and governance structure. Integra is an innovative and exciting company, with an entrepreneurial culture focused on teamwork and everyday excellence.


The UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director) with administrative and non-clinical tasks related to processing Utilization Management prior authorizations, pre-payment reviews, and appeals. 


  • Monitor incoming faxes
  • Enter UM authorizations and pre-payment review requests in UM platform using ICD-10 and HCPCS codes
  • Verify eligibility and claim history in proprietary claims platform
  • Verify all necessary documentation has been submitted with authorization requests
  • Contact requesting providers to obtain medical records or other necessary documentation related to specific UM request
  • Process pre-payment reviews for service requests not requiring a clinical review
  • Generate correspondence and assist with faxing/mailing member and provider notifications
  • Document as required in claims platform
  • Initiate appeal cases and forward to UM Nurses for completion
  • Meet internal and regulator deadlines for UM cases
  • Complete tasks assigned by UM Nurses and document as required
  • Other duties as assigned by UM Director


  • High school diploma required
  • 1 year as a UM Coordinator in a managed care payor environment required
  • Knowledge of ICD-10, HCPCS codes and medical terminology required
  • Ability to prioritize multiple tasks using time management and organizational skills
  • Strong computer skills with proficiency in Word, Outlook and other software applications
  • Ability to collect data, establish facts and draw valid conclusions
  • Effective written and oral communication skills
  • Experience with DMEPOS desired
  • Medicare/Medicaid experience a plus


  • Competitive compensation with bonus opportunity
  • 401(k) eligibility
  • Medical, Vision, Dental Benefits
  • Standard business hours
  • Paid Time Off (PTO); able to start using acquired time 90 days after hire
  • Collaborative and engaging office environment
  • Opportunity to be a key member of a rapidly growing company
  • Company sponsored events (holiday parties, sporting events, team building activities)
  • Company and department specific trainings


It is the policy of Integra Partners to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Integra Partners will provide reasonable accommodations for qualified individuals with disabilities.

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