Utilization Management Coordinator

First Stop Health

. Serve as a primary point of contact for members seeking healthcare navigation assistance .

Posted 10/23/2026full-timeRemote • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare navigation, including prior authorization processes and utilization management workflows, while providing exceptional customer service and communication. Proficient in coordinating care and collaborating across interdisciplinary teams to ensure timely and accurate support for members.

Highest-signal resume keywords

Healthcare Administration ExperiencePrior Authorization ProcessesUtilization Management SupportElectronic Medical Records (EMRs)Customer Service Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Healthcare NavigationPrior AuthorizationUtilization ManagementMedical TerminologyDocumentation AccuracyCase CoordinationHealth Insurance KnowledgeInterdisciplinary CollaborationTime ManagementOrganizational Skills

Soft Skills

Exceptional CommunicationAttention to DetailProfessionalismDiscretionMember-Centered Service

Tools & Technologies

Utilization Management SoftwarePayer PortalsMicrosoft Office SuiteHealthcare Information Systems

Industry Keywords

Healthcare AdministrationCustomer ServiceMedical Office OperationsManaged CareHIPAA Compliance

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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