Utilization Management Representative III
Core
Coordinating cases for precertification and prior authorization review for inpatient and outpatient services.
Role type
Utilization Management Representative
Builds
Prior authorization decisions and case coordination for healthcare services
Domain
Healthcare / Insurance
Deliverable
client delivery
Required skills
Medical terminology, customer service, multi-tasking, digital tools proficiency, problem-solving
Preferred skills
Master's degree (for certain contracts), facilitation skills, analytical skills
Responsibilities
Provide technical guidance to UM Reps on contract and benefit eligibility, handle escalated calls from team members, assist in new hire training, identify areas for process improvement
Seniority
Individual Contributor, Non-Management
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