Utilization Management Associate — Care Coordination Pro

Texas Health Institute; Pearland, Northern (TX, KY); Hybrid; USD 25,000 - 44,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive programs

Equity stock purchase

401k contribution

Job summary

Kelsey-Seybold Clinic, part of the Optum family, is seeking a Utilization Management Representative to support Utilization Management and Population Health programs, including authorization processing, record-keeping, and coordination with patients, providers, and payers.

You will enter data, assist with discharge planning, and serve as a resource for staff while upholding compliance and delivering high-quality care across our multi‑specialty clinics.

Qualifications

• High School Diploma or GED from an accredited program.
• 2+ years of managed care experience in a healthcare setting.
• 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.
• 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.

Skills

Managed care experience

Medical terminology

Data entry

Time management

Driver's license

Education

High School Diploma or GED

Tools

Epic

Job description

Kelsey-Seybold Clinic, part of the Optum family, is seeking a Utilization Management Representative to support Utilization Management and Population Health programs, including authorization processing, record-keeping, and coordination with patients, providers, and payers.

You will enter data, assist with discharge planning, and serve as a resource for staff while upholding compliance and delivering high-quality care across our multi‑specialty clinics.