Utilization Management Representative - Backoffice Support

Anticipated End Date:

Position Title: Utilization Management Representative I
- Backoffice Support

Job Description: Utilization Management Representative I
- Backoffice Support

This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

Monday through Friday. Candidates must be available to work an assigned shift between 8:00 a.m. and 8:00 p.m. Eastern Time
, based on business needs.

The Behavioral Health Utilization Management Representative I
- Backoffice Support is responsible for processing precertification, prior authorization, and post-service requests for governmental and commercial lines of business. This is primarily a back of office role with no inbound call responsibilities. Limited outbound calls may be required to obtain information or support case resolution.

• Reviews and processes utilization management requests received through fax, electronic queues, and other approved channels.
• Accurately enters referral and authorization information into utilization management systems.
• Prepares and sends clear, complete, and accurate fax correspondence to providers, facilities, members, and internal partners.
• Meets departmental productivity, quality, accuracy, and turnaround-time standards while maintaining a low error rate.
• Reviews documentation for completeness and refers cases requiring clinical review to the appropriate clinical reviewer.
• Verifies benefits and administrative requirements within the scope of the role.
• Documents all actions and correspondence accurately and completely.
• Demonstrates accountability and ownership of assigned workload by monitoring queues, prioritizing tasks, following work through completion, and escalating barriers promptly.
• Protects confidential information and complies with HIPAA, privacy and security requirements, company policies, accreditation standards, contractual obligations, and applicable federal and state regulations.
• Identifies and reports potential quality, privacy, compliance, or regulatory concerns through established escalation processes.
• Performs other duties as assigned.

• Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.

• Administrative support, healthcare operations, data entry, document processing, or back-office experience strongly preferred
• Medical terminology training and experience in medical or insurance field preferred
• For URAC accredited areas, the following professional competencies apply:
  Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
• Ability to meet established productivity, quality, accuracy, compliance, and turnaround-time expectations preferred
• Ability to manage assigned work independently, maintain confidentiality, and follow detailed policies and procedures preferred
• Proficiency with computers, electronic work queues, email, and document-management systems preferred
• Experience processing faxes, referrals,…