Utilization Management Representative

Job Summary

A company is looking for a Utilization Management Representative to assist in the administration of Utilization Management functions.

Key Responsibilities

• Process clinical information and manage authorizations and concurrent denials
• Communicate with insurance companies and external payor representatives to ensure proper authorization and documentation
• Perform data entry and maintain accurate records of patient information and insurance requirements

Required Qualifications

• High school diploma/GED or equivalent working knowledge
• Three years of experience in healthcare (e.g., Nursing Assistant, Medical Assistant, Patient Care Tech)
• Understanding of medical terminology
• Proficiency in organizational and time management skills
• Bilingual skills are preferred for some assignments