Remote Utilization Management Coordinator (Pre-Auth & Referrals)

Astrana Health Management; Orange, Northern (CA, KY); Hybrid; USD 30,000 - 33,000; Full time

Job summary

Astrana Health is seeking a Remote Utilization Management Coordinator in California to support clinical, management, and client activities within the UM program. You will handle pre-authorizations, retro reviews, and health plan contracts while ensuring timely, compliant referrals and maintaining confidentiality.

The role requires two years in managed care, knowledge of medical terminology, and strong organizational and communication skills.

Qualifications

• High School Graduate; Bachelor's in Healthcare Administration is a plus.
• Experience with authorizations or referrals in healthcare.
• Minimum of two years in a managed care environment (IPA or MSO preferred).
• Knowledge of medical terminology; including CPT, ICD-9 codes.
• Proficient with Microsoft applications.
• Good organizational skills; verbal and written communication.
• Ability to multitask and problem solve in a fast-paced environment.
• Punctual and detail-oriented.
• Ability to follow directions and work independently per department standards.
• Strong teamwork and attendance record.

Responsibilities

• Comply with UM policies and procedures; annual review of selected UM policies.
• Read and understand NMM UM Customer Service Policy and Procedures.
• Process routine and urgent treatment authorization requests according to policy.
• Attach incoming notes to appropriate authorizations.
• Move referrals back from eligibility/benefits to the correct review queue.
• Review and process daily assigned UM referrals (avg 150-250) per TAP guidelines.
• Verify benefits, eligibility, provider status, contracted vs non-contracted.
• Contact providers for clarification or notes as needed.
• Verify facilities are contracted or CMS approved when required.
• Attend provider and interdepartmental calls with strong customer service.
• Report daily activities or problems to UM Lead 3.
• Maintain confidentiality and relationships with health plans and medical directors.
• Assist team to meet turnaround times.

Skills

Authorizations experience

Managed care

Medical terminology

MS Office

Organizational skills

Communication skills

Multitasking

Punctuality

Team player

Attendance

Education

High School Graduate

Bachelor's in Healthcare Administration

Job description

Astrana Health is seeking a Remote Utilization Management Coordinator in California to support clinical, management, and client activities within the UM program. You will handle pre-authorizations, retro reviews, and health plan contracts while ensuring timely, compliant referrals and maintaining confidentiality.

The role requires two years in managed care, knowledge of medical terminology, and strong organizational and communication skills.