Sr. Utilization Management Coordinator - REMOTE

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Utilization Management Coordinator - REMOTE. In this role, you will assist and support the clinical team with various administrative and non-clinical tasks that are essential to the processing of Utilization Management prior authorizations and appeals. You will work closely with UM Nurses and the Medical Director to ensure that all requirements are met and documentation is complete. Your impact will be significant as you contribute to the efficiency of healthcare delivery, playing a key part in improving patient outcomes. The role requires strong organizational skills and the ability to adapt to a fast-paced environment, fostering collaboration and teamwork.

• Monitor incoming faxes
• Enter UM authorizations review requests using ICD-10 and HCPCS codes
• Verify eligibility and claim history in proprietary claims platform
• Ensure necessary documentation has been submitted with authorization requests
• Contact providers for medical records or documentation related to UM requests
• Generate correspondence and assist with member and provider notifications
• Complete verbal notifications
• Document as required in authorization platform
• Initiate appeal cases for UM Nurses to complete
• Meet internal and regulatory deadlines for UM cases
• Complete inquiries from call center and other sources
• Assist with other duties as assigned by UM Director

• 1 year as a UM Coordinator in a managed care payer environment preferred
• Knowledge of ICD-10, HCPCS codes, and medical terminology required
• Strong time management and organizational skills
• Proficiency in Word, Outlook, and other software applications
• Ability to collect data and draw valid conclusions
• Effective written and oral communication skills
• Experience with DMEPOS desired
• Medicare/Medicaid experience a plus

• Competitive compensation and annual bonus program
• 401(k) retirement program with company match
• Company-paid life insurance
• Company-paid short term disability coverage
• Medical, Vision, and Dental benefits
• Paid Time Off (PTO)
• Paid Parental Leave
• Sick Time
• Paid company holidays and floating holidays
• Quarterly company-sponsored events
• Health and wellness programs
• Career development opportunities

Why Apply Through Jobgether?

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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