Utilization Management Representative - Remote

UnitedHealth Group•Pearland, TX

1d•$16 - $29•Hybrid

About The Position

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation’s leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. The Utilization Management Representative (UMR) provides office support for all units within the Utilization Management and/or Population Health Department (Utilization Review, Concurrent Review, Population Health and Case Management). The UMR position will assist with incoming authorization requests, data entry of clinical information, and pre-certification requests. Additional responsibilities include direct communication with KSC Clinic Representatives as needed. The Utilization Management Representative is responsible for clerical support relative to the Bed Day process. Under the supervision of the Transfer Nurses, the Utilization Management Representative is primarily responsible for the collection, reporting, clarification, and entry of bed day data and pre and post-acute certification requests for specific services. Under the supervision of the Health Service Supervisor, the Utilization Management Representative is primarily responsible for collection of non-clinical data, report generation, health plan coordination for non-clinical issues, and other administrative duties required to provide comprehensive coordination of services. Additional duties can include handling and appropriately directing referral status requests received via phone and assisting with requesting clinical updates via phone and fax from facilities. Other duties as assigned. If you are located in Texas, you will have the flexibility to work remotely as you take on some tough challenges This position follows a hybrid schedule with three in-office days per week

Requirements

High School diploma or GED from an accredited program
Valid Texas driver's license
2+ years of managed care experience either in a physician office or hospital setting, health plan, ACO, or other managed care setting
Knowledge of medical terminology, HMO, PPO and referral processes
Alpha/numeric data entry and basic PC literacy
Proven excellent communication skills
Proven excellent time management skills

Nice To Haves

College level courses
Epic System usage
Knowledge of CPT & ICD 10 Coding methodologies

Responsibilities

Data entry of UR and/or Pop Health requests, admissions and discharge dates for inpatient services; address post-acute discharge needs into EPIC; address into the system including pre-cert for OB patients
Completion of clerical support tasks including incoming and outgoing fax requests, Xeroxing and filing, general mail support and correspondence received; generate reports for specific tasks (i.e. bed day)
Collaborate with external and internal customers to coordinate delivery of services and discharge planning as needed; including but not limited to making appointments, contacting patients regarding various issues, coordinating services between providers, payors and patients
Obtain authorizations from health plan for POS internal referrals and other services
Verify benefit interpretation and other communication from payors are entered into Kelsey-Seybold system
Serve as resource to clinic physicians, staff, payors and patients regarding pre-certification issues
Other duties as assigned