Utilization Management Coordinator

🔥 14 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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

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