Utilization Management Clinical Coordinator

Location: Remote within the United States; candidates must be based in the United States and authorized to work without sponsorship.

Annual salary for NYC-based applicants: $85,000–$100,000 USD, plus potential cash bonus and equity.

Company

hirify.global provides fertility, family-building, and women’s health benefits and clinical support solutions for employers, health plans, patients, and physicians.

What you will do

• Review utilization management cases and make evidence-based medical-necessity and authorization determinations.
• Review clinical dashboards, pending cases, documentation, correspondence, and faxes while meeting required service-level timelines.
• Contact providers to obtain authorization documentation and communicate determinations to providers and patients.
• Coordinate peer-to-peer reviews, appeals, independent review organization activities, audits, and related tracking.
• Prepare daily, weekly, quarterly, and annual reports and presentations for internal and external stakeholders.
• Manage workflow delegation, protect PHI under HIPAA requirements, identify process improvements, and provide utilization associate backup.

Requirements

• Bachelor’s degree in nursing and a current professional registered nurse license.
• At least 3 years of fertility nursing experience; utilization management experience is preferred.
• Knowledge of CPT, HCPCS, and ICD-10 codes, medical terminology, authorization processes, and clinical review requirements.
• Strong written, verbal, presentation, prioritization, multitasking, and independent-work skills.
• Experience with Salesforce, CRM platforms, reporting and dashboard management, JIRA bug reporting, and Microsoft Office.
• Must be based in the United States, have U.S. work authorization, and not require visa sponsorship now or in the future.

Culture & Benefits

• Health, dental, vision, and life insurance options for employees and families.
• Paid family and parental leave, fertility and family-building benefits, and family and pet care support.
• Paid vacation, sick leave, personal days, and summer flex time.
• 401(k) plan with company match, equity, and bonus program.
• Mental health and wellness support, legal and financial advice, learning programs, and mentorship.
• Flex days and office meals and snacks for employees reporting to the New York office.