Utilization & Care Coordination Specialist (Remote)

First Stop Health, LLC; Chicago (IL); Remote; USD 52,000 - 70,000; Full time

Benefits offered by this job

First Stop Health membership

401k match

Phone stipend

Summer Fridays

Job summary

First Stop Health, LLC is looking for a Utilization Management Coordinator to support members, providers, TPAs, and internal clinical staff across care journeys. This cross-trained role handles non-clinical tasks in Utilization Management, Prior Authorization, Care Navigation, and Case Management, acting as the first contact for incoming requests and ensuring timely, accurate processing.

Although non-clinical, the Coordinator escalates when clinical review is needed, collaborates with UM Nurses,

Qualifications

• Minimum 2 years in healthcare administration or related support roles.
• Experience with prior authorization processes and provider communications is preferred.
• Experience using EMRs, payer portals, and UM software is preferred.

Responsibilities

• Care Navigation & Member Support: act as primary contact for members seeking healthcare navigation.
• Prior Authorization Coordination: receive, review, and process authorization requests and ensure required information is included.
• Administrative Case Management Support: coordinate post-acute services and follow up on cases.
• Provider & Internal Team Collaboration: liaison between providers, members, TPAs, and internal teams.
• Clinical Escalation & Operational Excellence: escalate to UM Nurse per policies and maintain HIPAA compliance.

Skills

Exceptional customer service

Communication skills

Organizational skills

Time management

Prioritization

Verbal & written comms

Team collaboration

Healthcare terminology

Education

High school diploma or equivalent

Associate degree in healthcare administration or related field

Tools

EMRs

Payer portals

Utilisation management software

Job description

First Stop Health, LLC is looking for a Utilization Management Coordinator to support members, providers, TPAs, and internal clinical staff across care journeys. This cross-trained role handles non-clinical tasks in Utilization Management, Prior Authorization, Care Navigation, and Case Management, acting as the first contact for incoming requests and ensuring timely, accurate processing.

Although non-clinical, the Coordinator escalates when clinical review is needed, collaborates with UM Nurses,