Utilization Management Representative II
Core
Managing incoming calls to triage, open cases, and authorize inpatient admissions, outpatient precertification, and prior authorization requests.
Role type
Utilization Management Representative
Builds
Authorization decisions for healthcare services
Domain
Health Insurance / Utilization Management
Required skills
Medical terminology, Customer service, Data entry, Provider coordination, Clinical screening, Benefit verification
Preferred skills
Healthcare background, Medical insurance experience, Problem-solving, Analytical skills
Responsibilities
Manage incoming calls and triage requests; Determine contract and benefit eligibility; Obtain demographic information from callers; Conduct radius searches in Provider Finder; Refer cases requiring clinical review to nurse reviewers; Process requests for precertification and prior authorization; Verify benefits and eligibility information.
Seniority
Individual Contributor, Entry to Mid-level