Utilization Management Representative - Kelsey Seybold Clinic - Pearland

UnitedHealth Group•Pearland, TX

13h•$18 - $32•Onsite

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 administrative and operational support for Utilization Management and Population Health programs, including Utilization Review, Concurrent Review, Case Management, and Population Health initiatives. This role is responsible for processing authorization requests, maintaining accurate records, coordinating services, supporting discharge planning activities, and serving as a liaison between patients, providers, health plans, and internal care teams.

Requirements

High School Diploma or GED from an accredited program
2+ years of managed care experience in a physician office, hospital, health plan, ACO, or similar healthcare environment
Valid Texas Driver's License
Knowledge of medical terminology HMO, PPO, and referral processes
Alpha-numeric data entry and basic PC Literacy
Excellent time management skills

Nice To Haves

Experience using Epic
Knowledge of CPT and ICD-10 coding methodologies

Responsibilities

Process incoming authorization and pre-certification requests
Enter and maintain utilization management, admission, discharge, and clinical information in designated systems
Support bed day reporting, tracking, and data collection activities
Provide clerical and administrative support, including filing, faxing, correspondence management, and report generation
Coordinate care and discharge planning activities with patients, providers, payers, and internal stakeholders
Schedule appointments and assist with service coordination as needed
Obtain authorizations for referrals and covered services
Verify and document benefit information and payer communications
Serve as a resource for physicians, clinic staff, patients, and health plans regarding authorization and pre-certification processes
Respond to referral status requests and assist with obtaining clinical updates from facilities
Maintain accurate documentation and ensure compliance with organizational policies and procedures
Perform other duties as assigned