Hybrid Utilization Management Specialist

UnitedHealth Group; Pearland (TX); Hybrid; USD 25,000 - 44,000; Full time

Job summary

UnitedHealth Group's Kelsey-Seybold Pearland clinic is seeking an Utilization Management Representative to support UR and Population Health units. The role involves data entry, clerical tasks, and coordination with payors and providers to ensure timely authorizations and efficient discharge planning.

Responsibilities include generating reports, assisting with pre-certifications, and serving as a knowledge resource on pre-certification issues.

Qualifications

• High School diploma or GED required.
• 2+ years of managed care experience in physician office or hospital setting.
• Knowledge of medical terminology, HMO, PPO and referral processes.
• Alpha/numeric data entry and basic PC literacy.

Responsibilities

• Data entry of UR and/or Pop Health requests, admissions and discharge dates for inpatient services; address post-acute discharge needs into EPIC.
• Completion of clerical support tasks including fax requests, copying, filing, mail; generate reports.
• Collaborates with external and internal customers to coordinate delivery of services and discharge planning.
• Obtain authorizations from health plan for POS internal referrals and other services.
• Verifies benefit interpretation and other communication from payors are entered into Kelsey-Seybold system.
• Serves as resource to clinic physicians, staff, payors and patients regarding pre-certification issues.
• Other duties as assigned.

Skills

Data entry

Medical terminology

PC literacy

Managed care

HMO/PPO knowledge

Education

High School diploma or GED

Tools

Epic System usage

Job description

UnitedHealth Group's Kelsey-Seybold Pearland clinic is seeking an Utilization Management Representative to support UR and Population Health units. The role involves data entry, clerical tasks, and coordination with payors and providers to ensure timely authorizations and efficient discharge planning.

Responsibilities include generating reports, assisting with pre-certifications, and serving as a knowledge resource on pre-certification issues.