Utilization Management Representative

Major Duties and Responsibilities

• Responsible for coordinating cases for precertification and prior authorization review.
• Manages incoming calls, including triage, opening of cases and authorizing sessions.
• Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
• Responds to telephone and written inquiries from clients, providers and in‑house departments.
• Conducts clinical screening process. Authorizes initial set of sessions to provider.
• Checks benefits for facility based treatment.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

• High school diploma or equivalent.
• Minimum of 2 years of customer service call‑center experience is required.
• Experience in medical or insurance field strongly preferred.
• PC proficiency.