Utilization Management Associate — Remote-Friendly

PacificSource; Missouri; Hybrid; USD 36,000 - 57,000; Full time

Benefits offered by this job

Flexible telecommute policy

medical, vision, and dental insurance

incentive program

paid time off and holidays

401(k) plan

tuition reimbursement and training

life insurance

flexible spending account

Job summary

PacificSource is seeking a healthcare support professional to coordinate utilization management cases, validate preauthorization requirements, and document inpatient stays. You will work across departments to ensure accurate coding, benefits details, and compliance with HIPAA while maintaining a high level of member service and provider communication.

The role requires knowledge of CPT/HCPCS/ICD coding, strong organizational skills, and the ability to thrive in a fast-paced health insurance

Qualifications

• Two years of experience in health insurance industry or medical setting required.
• Basic knowledge of CPT/HCPCS/ICD coding and medical terminology.

Responsibilities

• Coordinate, create, and document UM cases in the electronic record.
• Validate preauthorization requirements and document plan types, benefits, eligibility, exclusions, and claims history.
• Communicate with members and providers about authorization, referrals and inpatient stays.
• Maintain HIPAA compliance and protect patient information.
• Assist in cross‑functional meetings and educate team members on UM processes.

Skills

Documentation

HIPAA compliance

Communication

Problem solving

Teamwork

Organisation

Adaptability

Customer service

Education

High school diploma or equivalent

Associate degree

Medical assistant certification

Licensed practical nurse / Certified professional coder

Tools

CPT/HCPCS/ICD coding

Job description

PacificSource is seeking a healthcare support professional to coordinate utilization management cases, validate preauthorization requirements, and document inpatient stays. You will work across departments to ensure accurate coding, benefits details, and compliance with HIPAA while maintaining a high level of member service and provider communication.

The role requires knowledge of CPT/HCPCS/ICD coding, strong organizational skills, and the ability to thrive in a fast-paced health insurance