Utilization Management Representative

Responsibilities

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, 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 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.

Job Title: Utilization Management Representative

Location: Pearland Administrative Office

Department: Utilization Management

Job Type: Full Time

Salary Range: $ 35,240 - $43,535 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)

Qualifications

Education

Required: High School diploma or GED from an accredited program

Preferred: College level courses

Experience

Required: 2 -3 years of managed care experience either in a physician office or hospital setting health plan,

ACO, or other managed care setting.

Preferred: Knowledge of CPT & ICD 10 Coding methodologies.

License(s)

Required: Valid Texas driver's license

Preferred: Epic System usage.

Special Skills

Required: Knowledge of medical terminology, HMO, PPO and referral processes.

Excellent communication skills

Alpha/numeric data entry and basic PC Literacy

Preferred: N/A

Other

Required: Excellent time management skills

Preferred: N/A

Working Environment: Office/Medical Office

About Us

Start your career journey and become a part of a community of renowned Healthcare professionals. Kelsey-Seybold Clinic is Houston's fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties.

Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares.

Why Kelsey-Seybold Clinic?

• Medical, Vision, and Dental

• Tuition Reimbursement

• Company Matching 401K

• Employee Reward and Recognition Program

• Paid time off for vacation, sick, and holidays

• Employee Assistance Program

• Continuing Medical Education allowance

Utilization Management Representative