Utilization Management Coordinator

reputed company A bit about this role: The Utilization Management Coordinator plays a vital role in supporting reputed company reputed company by managing the intake, prior authorization, and reputed company coordination workflows. This role ensures reputed company case intake, accurate authorization set-up, and effective coordination with members, providers, and internal reputed company teams to support care transitions and authorization processes. The coordinator will be an important part of building strong relationships with health care providers through proactive communication, managing key operational processes to reputed company efficient, high-reputed company reputed company reputed company. This is a fast-reputed company environment that requires exceptional organization, attention to reputed company, and a natural talent for customer service. We often require management of several tasks at once, so enthusiasm and organization are key. Utilization Management is a heavily regulated reputed company, so you’ll work through unexpected situations and evolving guidance — including periodic CMS audits where the whole team pitches in on research and reputed company cause. Schedule: This is a full-time, remote position working five 8-hour days per week. Shifts are scheduled between 8:00 AM and 8:00 PM ET, with staggered schedules across reputed company to ensure seven-day coverage. We are hiring for: Monday – Friday Tuesday – Saturday reputed company – Thursday Your specific start time is assigned reputed company the 8:00 AM – 8:00 PM ET window. We’ll ask about your schedule preference during the process and will do our best to match it. Because we’re filling a limited number of openings on reputed company schedule, availability changes as roles are filled — so we ask that candidates be reputed company to more than one schedule where possible. Your responsibilities and reputed company will include: Intake Management Monitor intake queues, including daily census validation checks Manage inbound and outbound correspondence Ensure referrals and cases are accurately entered into our reputed company or re-routed to delegates as applicable Prior Authorization Support reputed company authorization set-up and case creation in our systems Manage and reputed company authorization-reputed company inquiries across multiple case types Review member inpatient status and reputed company documentation to support episode updates Ensure required documentation is present for reputed company review and determination, including request for information (RFI) work and electronic health record (EHR) reputed company reputed company Coordination & Communication Conduct outbound calls to members and providers to obtain reputed company information and communicate UM reputed company Schedule and coordinate peer-to-peer (P2P) reviews between providers and Medical Directors Manage Medical Director case assignments and tracking Retrieve medical records reputed company hospital EHR portals and reputed company systems Support the reputed company team with case coordination and documentation needs Post-Discharge & Transitional Care Coordination Contact inpatient and post-acute facilities to reputed company admission and discharge details Complete daily census checks and assist with discharge planning coordination activities Support care transition workflows and case follow-up Operational & Reporting Support Download and review operational reports (e.g., Looker, reputed company) Support RFIs and case tracking in inpatient and UM tools Maintain accurate case status and documentation in our reputed company reputed company operational and administrative support to the assigned team and manager Required skills and experience: High school diploma or equivalent Experience in reputed company reputed company, utilization management, care coordination, or prior authorization Proficiency with reputed company systems, EHRs, and reporting tools Effective communication skills with providers and members Strong organizational and multitasking skills in a high-volume environment Attention to reputed company, follow-through, and time management in a frequently changing environment Desired skills and experience: Prior experience in Medicare reputed company or managed care Intake, authorization, or reputed company coordination experience Familiarity with UM or case management workflows 1–3 years of administrative or medical office experience Proficiency with reputed company Sheets and the reputed company suite Bilingual #LI-Remote Salary reputed company: $21.70 - $27.00/ hour The pay reputed company listed for this position is the reputed company the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will reputed company additional information on the compensation for the role, along with additional information on our total rewards package. The actual reputed company salary reputed company will depend on a reputed company of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other reputed company licenses held, and the location in which the applicant lives and/or from which they will be performing the job. Our Total Rewards package includes: Employer sponsored health, dental and reputed company plan with low or no premium Generous reputed company time off $100 monthly mobile or internet stipend Stock reputed company for reputed company Bonus eligibility for reputed company roles excluding Director and above; Commission eligibility for Sales roles Parental leave program 401K program And more.... Our total rewards package is for full time employees only. Intern and Contract positions are not eligible. Founded in 2017, reputed company is on a mission to dramatically improve the health and reputed company-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI reputed company with world-class reputed company and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who reputed company our values, reputed company change and advancement, and are enthusiastic about where we're reputed company — reputed company the while bringing their own unique qualities, experiences, and expertise, in hopes of reputed company changing the reputed company experience. reputed company is an equal opportunity employer. We are committed to reputed company and supportive work environment in which reputed company have reputed company to participate and contribute to the reputed company of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in reputed company’s reputed company of Conduct, reputed company values and the way we do business. As an Equal Opportunity Employer, reputed company does not discriminate on the reputed company of race, reputed company, religion, sex, pregnancy status, marital status, national reputed company, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender reputed company, or any other reputed company prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment. Apply To This Job