{"id":2952016,"url":"https://alion.io/job/first-stop-health-utilization-management-um-coordinator","title":"Utilization Management (UM) Coordinator","company":{"id":2324549,"name":"First Stop Health","domain":"firststophealth.com","url":"https://alion.io/company/firststophealth","size_band":"201-500","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Paylocity","truth_index":null},"role":"Administrative","role_family":"Administrative","seniority":"junior","employment_type":"full_time","work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"inferred_company_offices","remote_working_hours":null,"hiring_geo_confidence":"inferred","locations":[],"countries":[],"hiring_countries":["US"],"hiring_countries_total":1,"salary":null,"salary_estimate":{"min_usd":37000,"max_usd":62000,"period":"year","method":"global_role_seniority_cell","sample_n":5190},"experience_years_min":2,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"HIPAA","optional":false},{"name":"Microsoft Office","optional":false}],"status":"live","first_seen_at":"2026-10-20T18:38:09Z","employer_posted_date":"2026-10-20","last_verified_at":"2026-10-22T04:43:49Z","board_verified":true,"closed_at":null,"days_open":1,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":1},"description":"Description\nAbout Us:\nOn a mission to deliver affordable, delightful healthcare for all, First Stop Health provides connected, whole-person virtual care to employers 24/7 through app, website, or phone in all 50 states. First Stop Health prioritizes an engaging and easy-to-use experience, setting people on healthier journeys through care at multiple stages. We are proud to be recognized as one of Fast Company’s Most Innovative Companies.\nFirst Stop Health offers a comprehensive benefits package that includes various health and medical coverage options, dental and vision coverage, disability and life coverage, making healthcare easily accessible. For those that choose to waive medical coverage a monthly medical waiver allowance will be provided.\nFirst Stop Health offers a remote-first work environment and flexible paid time off, including Summer Fridays. Furthermore, the employer match 401k plan and monthly phone stipend demonstrates the company's commitment to employee financial well-being. The First Stop Health membership benefit is another added perk for employees and provides our virtual care solutions -- Urgent Care, Mental Health, and Primary Care -- from their very first day!\nJob Description:\nThe Utilization Management (UM) Coordinator serves as a central administrative resource within the Utilization Management team, supporting members, providers, TPAs and internal clinical staff throughout the care journey. This cross-trained role performs a wide range of non-clinical functions across Utilization Management, Prior Authorization, Care Navigation, and Case Management activities.\nThe UM Coordinator acts as the first point of contact for many incoming requests, ensuring work is accurately received, prioritized, coordinated, and resolved whenever possible. The Coordinator facilitates communication between members, providers, and internal teams while supporting timely access to care, efficient authorization processing, and post-service coordination.\nAlthough the role is non-clinical, the UM Coordinator plays an important role in identifying situations that require clinical review. When a member, provider, or case exceeds the established non-clinical scope, the Coordinator promptly escalates the request to a UM Nurse or leadership according to established clinical escalation guidelines.\nResponsibilities:\nCare Navigation & Member Support\nServe as a primary point of contact for members seeking assistance with healthcare navigation.\nAssist members with locating in-network providers and participating facilities.\nProvide general education regarding health plan processes, benefits navigation, and available First Stop Health services within established guidelines.\nRoute members to the appropriate internal department or external resource based on identified needs.\nDocument all interactions accurately and thoroughly within designated systems.\nIdentify situations requiring clinical intervention and immediately escalate to a UM Nurse or leadership.\nPrior Authorization Coordination\nReceive, review, and process incoming prior authorization requests submitted via fax, portal, phone, or other approved channels.\nEnsure requests contain required demographic, administrative information and clinical information prior to clinical review.\nServe as the primary administrative liaison with provider offices by obtaining required documentation, communicating case status, requesting additional information, and performing administrative outreach and follow-up as directed by the UM Nurse.\nMonitor authorization work queues to support timely turnaround times, proactively follow up on outstanding items, and escalate potential delays to the appropriate clinical team member as needed.\nMaintain accurate documentation throughout the authorization process.\nAdministrative Case Management Support\nCoordinate post-acute services for designated cases as assigned.\nAssist members undergoing outpatient orthopedic procedures (including total hip and total knee replacements) by coordinating durable medical equipment (DME), home health services, and other approved post-procedure needs.\nPerform follow-up outreach on cases delegated by UM Nurses.\nTrack assigned cases to completion and communicate updates to the clinical team as appropriate.\nPromptly escalate any newly identified clinical concerns to the assigned UM Nurse in accordance with established clinical escalation protocols.\nProvider & Internal Team Collaboration\nServe as a liaison between providers, members, TPAs and internal First Stop Health departments.\nCoordinate administrative follow-up activities to facilitate timely care delivery.\nRespond to provider office inquiries in a professional, courteous, and service-oriented manner, resolving non-clinical issues whenever possible.\nCollaborate closely with UM Nurses to ensure smooth transitions when clinical review becomes necessary, per escalation protocol.\nSupport department workflow by assisting across multiple functional areas based on operational priorities\nClinical Escalation & Operational Excellence\nRecognize situations that exceed the non-clinical scope of practice, within established clinical escalation protocols.\nPromptly communicate clinical concerns to a UM Nurse or leadership through established escalation pathways.\nMaintain confidentiality and comply with HIPAA and organizational policies.\nParticipate in cross-training initiatives to support evolving departmental needs.\nContribute to quality improvement efforts through accurate documentation, attention to detail, and continuous process improvement.\nDemonstrate exceptional customer service while supporting members and provider partners through every interaction.\nPerform other duties and special projects as assigned to support departmental and organizational objectives.\nRequirements:\nEducation:\nHigh school diploma or equivalent required.\nAssociate degree in healthcare administration, business, or a related field preferred.\nExperience:\nMinimum of 2 years of experience in healthcare administration, utilization management support, care coordination, customer service, health insurance, medical office operations, or a related healthcare setting required.\nExperience working with prior authorization processes, provider office communication, managed care, or case coordination preferred.\nExperience using electronic medical records (EMRs), payer portals, and utilization management software preferred.\nSkills:\nExceptional customer service and communication skills.\nStrong organizational and time management abilities.\nAbility to prioritize multiple tasks in a fast-paced environment.\nExcellent verbal and written communication.\nStrong attention to detail and documentation accuracy.\nAbility to work collaboratively across interdisciplinary teams.\nKnowledge of medical terminology preferred.\nUnderstanding of health insurance, utilization management, and prior authorization workflows preferred.\nProficiency in Microsoft Office Suite and healthcare information systems.\nAbility to recognize situations requiring clinical escalation and follow established escalation protocols.\nDemonstrated professionalism, discretion, and commitment to member-centered service.\nFirst Stop Health is committed to diversity, equity, inclusion, and belonging. Research shows that women, people of color and other historically underrepresented groups tend to only apply to jobs in which they meet all the job requirements. Unsure if you check every box? Apply. We would love to consider your unique experiences and how you could make First Stop Health even better.\nTo learn more about First Stop Health, visit www.fshealth.com and if you require any assistance during the application process or have questions, please don't hesitate to contact our talent acquisition team via email at ","description_format":"text","description_chars":7814,"description_truncated":false,"requirements":{"experience_years_min":2,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"high_school","optional":true},"security_clearance":false,"languages":[]},"benefits":["401k plan","Equity","Health insurance"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["Health Care","Telemedicine & Virtual Care","Primary Care & Medical Centers"],"lifecycle":[{"event":"open","at":"2026-10-20T20:24:05Z"}],"visa":[],"liveness":{"score":86,"band":"hot","label":"Hiring now","p_open":1,"p_active":0.86,"p_room":1,"age_days":0,"expected_fill_days":29,"reasons":["conf:0","win:early","comp:junior"],"computed_at":"2026-10-21T05:46:15Z"},"pay":null,"html_url":"https://alion.io/job/first-stop-health-utilization-management-um-coordinator","json_url":"https://alion.io/job/first-stop-health-utilization-management-um-coordinator.json","meta":{"generated_at":"2026-10-22T06:01:30Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":718,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-10-23T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":2324549},"rest":"https://alion.io/mcp/rest/get_company?id=2324549"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Ffirst-stop-health-utilization-management-um-coordinator"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Ffirst-stop-health-utilization-management-um-coordinator"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Ffirst-stop-health-utilization-management-um-coordinator"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/first-stop-health-utilization-management-um-coordinator\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Ffirst-stop-health-utilization-management-um-coordinator"}]}