Medical Coordinator

Company DescriptionVIP Universal Medical Insurance Group (VUMI®) is an international health insurance organization offering major medical insurance products and specialized VIP medical services to individuals and corporations worldwide. VUMI provides a wide variety of health plans, including access to features such as Second Medical Opinion VIP®, global telemedicine, and at-home doctor visits. With offices across the United States, Canada, the United Arab Emirates, Latin America, and Europe, VUMI operates as part of a global healthcare management group with over 40 years of industry experience. The company employs more than 590 professionals of diverse nationalities, ensuring comprehensive global expertise and service.
Medical CoordinatorWe are looking for a Medical Coordinator who is passionate about delivering an exceptional member experience throughout the healthcare journey.In this role, you will coordinate medical care, manage Level 0 authorizations, review clinical documentation, and collaborate with a global network of healthcare providers. As the primary liaison between members, brokers, providers, hospitals, and the internal Case Management team, you will play a key role in ensuring timely, high-quality, and cost-effective care.
Availability to work rotating on-call shifts, including weekday on-call coverage from 5:00 PM to 9:00 AM, and 24-hour weekend on-call shifts based on a rotating schedule.
Key ResponsibilitiesServe as the primary point of contact for members throughout the medical care process, from pre-authorization requests through hospital discharge.Manage eligibility verification, notifications, pre-authorizations, and Level 0 medical authorizations while meeting established service levels.Review clinical documentation and apply medical necessity criteria in accordance with company policies and policy provisions.Coordinate care with hospitals, physicians, clinics, and healthcare providers worldwide to ensure seamless and timely service.Clearly explain policy benefits, coverage, exclusions, deductibles, coinsurance, and member financial responsibilities.Provide proactive follow-up to members, families, brokers, and providers during hospitalizations and ongoing treatments.Escalate complex clinical cases to the Medical Evaluator with complete and accurate documentation.Negotiate provider fees and promote cost-effective treatment options while maintaining quality of care.Identify and report potential fraud, waste, or abuse in accordance with company procedures.Maintain accurate and complete case documentation, authorizations, and clinical records in internal systems.Collaborate with multidisciplinary teams to ensure continuity of care, regulatory compliance, and an outstanding member experience.Support quality improvement initiatives, audits, and operational projects.
QualificationsBachelor's degree in a Health Sciences field such as Nursing, Medicine, Healthcare Administration, Social Work in Healthcare, or a related discipline.Minimum of 2–3 years of experience in Case Management, medical pre-authorizations, care coordination, health insurance, TPA, international medical assistance, or healthcare provider organizations.Strong knowledge of international health insurance plans, including benefits, exclusions, deductibles, coinsurance, and coverage limits.Ability to review clinical documentation and apply medical necessity criteria within the scope of Level 0 authorizations.Experience using Case Management platforms and clinical management systems.Advanced English proficiency (written and verbal); English is the primary working language.Strong negotiation skills with healthcare providers and the ability to manage costs within policy guidelines.Knowledge of healthcare and insurance regulations applicable to Latin America and the United States/Canada.Portuguese language is a plus.