Utilization Management Representative II

CareBridge • Garden Grove, CA

81d • $19 - $31

About The Position

The Utilization Management Representative II is responsible for conducting service coordination functions for a defined caseload of individuals. This role enables associates to work virtually full-time in CALIFORNIA, with the exception of 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.

Requirements

• Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

• 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.
• Previous experience working in a social work setting preferred.
• BA/BS degree is preferred in the field of health care.
• Specific education, years and type of experience may be required based upon state law and contract requirements.

Responsibilities

• Managing incoming calls
• Determine contract and benefit eligibility; creates authorizations for LTSS members.
• Obtains intake (demographic) information from LTSS providers.
• Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care.
• Processes incoming requests, collection of information needed for review from providers.
• Verifies benefits and/or eligibility information.
• May act as a liaison between LTSS and internal departments.
• Responds to telephone and written inquiries from providers and in-house departments.
• Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long term services and supports.
• May also serve as to mentor, subject matter expert or preceptor for new staff, assisting the formal training of associates, and may be involved in process improvement initiatives.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Paid holidays
• Paid Time Off
• Medical, dental, vision benefits
• Short and long term disability benefits
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Ambulatory Health Care Services
• Education Level: High school or GED
• Number of Employees: 251-500 employees