Part-Time Utilization Review Coordinator, Pre Adm - Hybrid

Utilization Review Coordinator (RN) - Outpatient Kidney Transplant UPMC Presbyterian | Oakland, PA Make a Lasting Impact on the Lives of Transplant Patients Are you an experienced Registered Nurse with a background in managed care, utilization review, care coordination, or insurance authorization? Do you want to use your clinical expertise to help transplant patients access the care they need? UPMC Presbyterian's nationally recognized Outpatient Kidney Transplant Division is seeking a Utilization Review Coordinator (RN) to join our dedicated team.

In this role, you'll collaborate with healthcare providers, insurance companies, and transplant professionals to help ensure patients receive timely approvals for critical treatments, procedures, medications, and hospital services. If you're passionate about patient advocacy, enjoy problem-solving, and want a meaningful role with excellent work-life balance, we'd love to hear from you!

Our Team? ✅ Flexible daytime schedule ✅ No weekends, holidays, or on-call responsibilities ✅ Hybrid work opportunity ✅ Meaningful work supporting transplant patients throughout their care journey ✅ Collaborative and mission-driven transplant team Schedule & Work Arrangement Part-time position requiring a minimum of 20 hours per week Flexible work schedule between 8:00 AM and 4:30 PM, Monday through Friday Primarily remote work environment One required on-site check-in each month at our Oakland location

Serve as a liaison between physician offices and insurance providers to secure authorization and reimbursement for medications, treatments, procedures, and hospital admissions. Obtain and communicate treatment plans, diagnoses, and supporting clinical documentation to insurance carriers and regulatory agencies. Support transplant coordinators and clinical staff by facilitating the authorization process and helping remove barriers to patient care.

Provide guidance regarding payer-specific requirements, regulations, and reimbursement processes. Maintain accurate authorization records and ensure compliance with HIPAA and applicable regulatory standards. Collaborate with interdisciplinary teams to support positive patient outcomes.

Participate in professional development and continuing education opportunities. Demonstrate UPMC's commitment to exceptional patient and customer service. Help Transplant Patients Receive the Care They Need Join a team where your clinical knowledge and advocacy make a direct difference in patient outcomes.

Apply today and become part of UPMC Presbyterian's commitment to life-changing Registered Nurse (RN) Diploma or Associate Degree in Nursing Minimum of 2 years of recent clinical nursing experience Strong organizational and time-management skills Excellent verbal and written communication skills Ability to manage multiple priorities while maintaining attention to detail Ability to analyze, interpret, and communicate information relevant to the authorization process Preferred Utilization review or pre-authorization experience Managed care experience Transplant experience Knowledge of third-party payer regulations and reimbursement practices Understanding of treatment needs within the transplant patient population Licensure & Clearances Current Registered Nurse (RN) license Act 34 Criminal Clearance