Utilization Management Coordinator

🕒 5 days ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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First Stop Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2011

🏥 Healthcare

⚕️ Healthcare Insurance

👥 B2C

Healthcare • Healthcare Insurance • B2C

First Stop Health is a comprehensive virtual healthcare provider that offers a range of services including urgent care, primary care, mental health counseling, and health coaching. Designed for both individuals and businesses, First Stop Health aims to create a delightful healthcare experience by providing accessible, affordable, and engaging care options. Their team consists of board-certified doctors, registered dietitians, health coaches, and licensed therapists who collaborate to support the complete health journey of their patients, ensuring that care is available anytime, anywhere, through a user-friendly digital platform.

📋 Description

• Serve as a primary point of contact for members seeking healthcare navigation assistance • Assist members with locating in-network providers and participating facilities • Provide general education regarding health plan processes, benefits navigation, and available First Stop Health services • Route members to appropriate internal departments or external resources • Document interactions accurately in designated systems • Identify situations requiring clinical intervention and escalate to a UM Nurse or leadership • Receive, review, and process prior authorization requests submitted via fax, portal, phone, or other approved channels • Verify requests contain required demographic, administrative, and clinical information before clinical review • Liaise with provider offices by obtaining documentation, communicating case status, requesting information, and performing administrative follow-up • Monitor authorization work queues and follow up on outstanding items to support timely turnaround • Coordinate post-acute services for designated cases • Coordinate DME, home health services, and other approved post-procedure needs for outpatient orthopedic procedures • Perform follow-up outreach on cases delegated by UM Nurses • Track assigned cases to completion and communicate updates to the clinical team • Serve as a liaison between providers, members, TPAs, and internal departments • Respond to provider inquiries and resolve non-clinical issues when possible • Support department workflow across multiple functional areas • Communicate clinical concerns through established escalation pathways • Participate in cross-training initiatives and quality improvement efforts • Perform other duties and special projects as assigned

🎯 Requirements

• High school diploma or equivalent required • Minimum of 2 years of experience in healthcare administration, utilization management support, care coordination, customer service, health insurance, medical office operations, or a related healthcare setting required • Experience working with prior authorization processes, provider office communication, managed care, or case coordination preferred • Experience using electronic medical records (EMRs), payer portals, and utilization management software preferred • Exceptional customer service and communication skills • Strong organizational and time management abilities • Ability to prioritize multiple tasks in a fast-paced environment • Excellent verbal and written communication • Strong attention to detail and documentation accuracy • Ability to work collaboratively across interdisciplinary teams • Knowledge of medical terminology preferred • Understanding of health insurance, utilization management, and prior authorization workflows preferred • Proficiency in Microsoft Office Suite and healthcare information systems • Ability to recognize situations requiring clinical escalation and follow established escalation protocols • Demonstrated professionalism, discretion, and commitment to member-centered service • Ability to maintain confidentiality and comply with HIPAA and organizational policies

🏖️ Benefits

• Various health and medical coverage options • Dental and vision coverage • Disability and life coverage • Monthly medical waiver allowance for employees who waive medical coverage • Remote-first work environment • Flexible paid time off, including Summer Fridays • Employer-match 401(k) plan • Monthly phone stipend • First Stop Health membership benefit providing Urgent Care, Mental Health, and Primary Care from the first day

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