Utilization Management Representative Kelsey Seybold Clinic

Kelsey-Seybold Clinic•Brookside Vl, TX

56d•$16 - $29

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.

Requirements

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

Nice To Haves

Knowledge of CPT & ICD 10 Coding methodologies
Epic System usage

Responsibilities

Provides office support for all units within the Utilization Management and/or Population Health Department. (Utilization Review, Concurrent Review, Population Health and Case Management.)
Assist with incoming authorization requests; data entry of clinical information, pre-certification requests
Direct communication with KSC Clinic Representatives as needed
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 that are 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