Utilization Management Representative - Hybrid-Kelsey Seybold Pearland TX

UnitedHealth Group•Pearland, TX

7d•$18 - $32•Hybrid

About The Position

The Utilization Management Representative (UMR) provides office and clerical support to units within the Utilization Management and/or Population Health Department, including Utilization Review, Concurrent Review, Population Health, and Case Management. The representative assists with incoming authorization requests and enters clinical information and pre-certification requests. The role also involves communication with Kelsey-Seybold Clinic representatives and clerical support for the Bed Day process. Under the supervision of Transfer Nurses, the UMR collects, reports, clarifies, and enters bed day data and pre- and post-acute certification requests for specific services. Under the supervision of the Health Service Supervisor, the UMR collects non-clinical data, generates reports, coordinates with health plans on non-clinical issues, and performs administrative duties that support coordination of services. Additional duties may include directing referral status requests received by phone and requesting clinical updates from facilities by phone and fax. Other duties may be assigned. The position is based in Pearland, Texas, and is described as hybrid. The listed hourly pay range is $18–$32, based on full-time employment and factors including local labor markets, education, work experience, and certifications. The employer describes a comprehensive benefits package, incentive and recognition programs, an equity stock purchase plan, and a 401(k) contribution, subject to eligibility requirements. Candidates must pass a drug test before beginning employment.

Requirements

High school diploma or GED from an accredited program.
At least 2 years of managed care experience in a physician office, hospital setting, health plan, ACO, or other managed care setting.
Knowledge of medical terminology, HMO and PPO plans, and referral processes.
Excellent communication skills.
Alpha/numeric data-entry skills and basic PC literacy.
Excellent time-management skills.
Valid Texas driver’s license.

Nice To Haves

College-level courses.
Knowledge of CPT and ICD-10 coding methodologies.
Experience using the Epic system.

Responsibilities

Enter Utilization Review and/or Population Health requests, inpatient admissions and discharge dates, post-acute discharge needs, and pre-certification information for OB patients into EPIC.
Complete clerical support tasks, including processing incoming and outgoing faxes, Xeroxing, filing, handling general mail, and processing correspondence.
Generate reports for specific tasks, including bed day reporting.
Collaborate with internal and external customers to coordinate service delivery and discharge planning, including appointments and communications with patients, providers, and payers.
Obtain health plan authorizations for point-of-service internal referrals and other services.
Enter benefit interpretations and other payor communications into the Kelsey-Seybold system.
Serve as a resource to clinic physicians, staff, payors, and patients regarding pre-certification issues.
Collect, report, clarify, and enter bed day data and pre- and post-acute certification requests under Transfer Nurse supervision.
Collect non-clinical data, coordinate with health plans on non-clinical issues, and perform administrative service-coordination duties under Health Service Supervisor supervision.
Handle and appropriately direct referral status requests received by phone, and request clinical updates from facilities by phone and fax.
Perform other duties as assigned.