Utilization Management Associate

. Assist the Utilization Management program by providing administrative support to the Utilization Review department .

Posted 9/25/2026full-timeRemote • United StatesJuniorMid-LevelWebsite

Key responsibilities & impact

Assist the Utilization Management program by providing administrative support to the Utilization Review department
Perform intake, screening, and precertification of appropriate healthcare services
Assist Clinical Care Nurses with clerical tasks related to discharge planning and utilization review
Monitor member eligibility
Conduct outreach calls to hospitals for follow-up clinical and discharge information
Process new admissions, including updating patient demographics, creating cases in BabyTrax®, documenting cases in the client system, and assigning Clinical Care Nurses
Communicate verbal and written prior authorizations according to client specifications
Receive incoming Utilization Management calls and refer them to appropriate staff
Maintain compliance with policies, procedures, regulations, patient safety, risk management, regulatory, and accreditation requirements
Maintain accurate and complete documentation
Provide additional support and project work across Care Management areas as needed
Report to the Supervisor of Utilization Review

What you’ll need

1–3 years of experience in customer service in a healthcare environment
HS diploma or equivalent required
College degree preferred
Insurance/payor experience preferred
Working knowledge of healthcare terminology
Professional verbal and written communication skills
Problem-solving skills with the ability to identify root causes and implement workable solutions
Intermediate to advanced proficiency in Outlook, Excel, PowerPoint, and Word
Must be fluent in English
Proficiency in a second language is highly desirable
Self-motivated and willing to learn multiple tasks
Well-organized and able to prioritize tasks
Commitment to excellence in customer service

Comp & perks