Utilization Management Rep

Job Title: Utilization Management Representative (UMR)Work Location: 11511 Shadow Creek ParkwaySchedule: Monday – Friday | 8:00 AM – 5:00 PM | 24–40 hours per weekInterview Process: Virtual interview via cameraDress Code: Business CasualPay Rate: 13/hr (Paid Weekly)Allmed Benefits: Vision, Health, Dental Insurance & 401(k)Position OverviewThe Utilization Management Representative (UMR) plays a critical role in supporting Utilization Management operations by ensuring the timely and accurate processing of authorization requests and communicating authorization determinations to providers and members. This role directly supports regulatory compliance, operational efficiency, and quality patient care by facilitating appropriate utilization of healthcare services.The UMR serves as a key point of contact between providers, members, and the clinical review team while supporting overall care management strategies through efficient workflow management and effective communication.Team EnvironmentThe selected candidate will join a collaborative Utilization Management team consisting of approximately 20 Utilization Management Representatives (UMRs) working alongside clinical reviewers, including Registered Nurses (RNs), LVNs, and Medical Directors.The team operates in a fast-paced, production-driven environment where accuracy, efficiency, and teamwork are critical to success. Team culture emphasizes:Collaboration and strong communicationAccountability for productivity and quality metricsContinuous learning and process improvementSupportive teamwork across clinical and operational departmentsCommitment to regulatory compliance and quality member careTeam members regularly collaborate with internal departments including clinical review teams, provider relations, claims, and appeals teams.Key ResponsibilitiesAnswer inbound calls from providers, members, and healthcare facilities regarding authorization requests, status updates, and coverage questionsCreate authorization cases by reviewing and processing clinical requests received through fax, electronic submissions, or phone communicationAccurately document authorization requests within utilization management systems and/or electronic medical record systemsCoordinate with clinical review staff, including RNs, LVNs, and Medical Directors, to appropriately route cases requiring medical necessity reviewCommunicate authorization determinations verbally to providers and members in compliance with regulatory guidelines and organizational requirementsMaintain accurate records and ensure documentation standards are consistently metSupport workflow efficiency while managing multiple priorities in a high-volume environmentProvide exceptional customer service while maintaining confidentiality and professionalismRequired Qualifications1–3 years of healthcare experience, preferably within:Utilization ManagementInsurance operationsMedical office environmentsManaged care settingsExperience handling high-volume calls in a professional and efficient mannerStrong data entry and documentation skills with high attention to detailAbility to effectively manage multiple tasks simultaneously in a fast-paced environmentStrong verbal and written communication skills when interacting with providers, members, and internal teamsBasic understanding of healthcare authorization processes and insurance workflowsExperience using EMR/EHR platforms, case management systems, or related healthcare systemsStrong organizational and time-management skillsPreferred QualificationsExperience supporting authorization processes within healthcare operations or managed care settingsPrevious experience in health plans, hospitals, medical offices, or healthcare call center environmentsExperience working with provider communication and care coordination activities\#ZR