Remote UM Coordinator I - Care & Authorization Expert

North East Medical Services; United States; On-site; USD 55,000 - 75,000; Full time

Job summary

North East Medical Services is seeking an Utilization Management Coordinator I to work remotely in the United States. Under supervision of a physician or RN, you will review and authorize inpatient and outpatient services and support care coordination for approved services.

The role requires strong data entry, medical terminology knowledge, and excellent communication skills. You will stay updated on regulations and liaise with health plans, patients, and families to ensure timely decisions.

Qualifications

• Diploma or higher required.
• Knowledge of medical terminology.
• Completion of a Medical Assistant degree or certificate a plus.
• Excellent data entry skills.
• Working knowledge of managed-care a plus.
• Strong communication, analytical, and problem-solving skills.
• Knowledge of community resources and cultural needs.
• Good organization and prioritization skills, time management.

Responsibilities

• Review referrals and treatment authorization requests for inpatient and outpatient services.
• Process and approve authorization requests per guidelines.
• Research clinical guidelines for complex cases.
• Prepare and present complex cases to Medical Director for review.
• Carry out care coordination with members, families, and providers.
• Provide customer service for UM inquiries to PCPs, specialists, and members.
• Stay current with DHCS regulations and health plan agreements.

Skills

Data entry

Communication

Analytical

Problem solving

Medical terminology

Managed-care

Time management

Organization

Cultural competence

Clinic experience

Education

Diploma or higher

Medical Assistant degree/certificate

Job description

North East Medical Services is seeking an Utilization Management Coordinator I to work remotely in the United States. Under supervision of a physician or RN, you will review and authorize inpatient and outpatient services and support care coordination for approved services.

The role requires strong data entry, medical terminology knowledge, and excellent communication skills. You will stay updated on regulations and liaise with health plans, patients, and families to ensure timely decisions.