Utilization Management Coordinator

🔥 13 hours ago

🏄 California – Remote

🏄 California – Remote

💵 $22 - $25 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Astrana Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

💼 Consulting

📦 Logistics

🏥 Healthcare

Consulting • Logistics • Healthcare

Astrana Health is a healthcare company that operates community-focused clinics and a provider-facing technology platform to coordinate care across primary, urgent, and multi-specialty services. It supports providers and local communities by streamlining access to care, automating prior authorizations, and connecting patients with in-network clinicians. Astrana combines clinical services with doctor-built technology to improve patient experience and provider workflows.

📋 Description

• Support clinical, management, and client activities comprising the Utilization Management Program • Understand and apply UM processes, including pre-authorizations, retro reviews, Division of Financial Responsibilities, and health plan contracts • Ensure quality referrals are processed timely according to health plan standards • Comply with UM policies and procedures and review selected policies annually • Read and understand NMM UM Customer Service policies and procedures • Process routine and urgent treatment authorization requests according to the NMM Policy & Procedure Manual and UM Level 1 review process • Attach incoming notes to appropriate authorizations • Route referrals returned from eligibility or benefits to the correct review queue • Review, screen, and process 150–250 assigned UM referrals daily in accordance with IPA and health plan turnaround-time guidelines • Verify benefit matrix through DOFR, eligibility, provider status, contracted/non-contracted status, carve-outs, and related information • Contact provider offices for clarification, notes, or redirections • Verify facilities are contracted or CMS-approved when required • Handle provider and interdepartmental calls with exceptional customer service • Report daily activities and problems to UM Lead 3 • Maintain strict confidentiality • Maintain relationships with health plans, medical directors, and external contacts • Assist team members as needed to meet turnaround-time requirements • Perform other duties as assigned

🎯 Requirements

• High School Graduate • Bachelor's in Healthcare Administration is a plus • Experience with authorizations or referrals in healthcare • A minimum of two years of experience in a managed care environment, including an IPA or MSO, preferred • Knowledge of medical terminology, RVS, CPT, HPCS, and ICD-9 codes • Proficient with Microsoft applications • Good organizational skills • Verbal and written communication skills • Ability to multitask and problem solve in a fast-paced work environment • Punctuality and attention to detail • Ability to follow directions and work independently according to department standards • Strong team player • Excellent attendance record

🏖️ Benefits

• Remote position; candidates must reside in California • Monday–Friday schedule, typically 8:00 am–5:00 pm • Up to 1 hour of voluntary overtime per day • Equal Employment Opportunity and Affirmative Action employer • Disability accommodation support during application