Utilization Management Representative

Direct Staffing Inc; City of Albany (NY); On-site; USD 42,000 - 54,000; Full time

Job summary

A staffing agency is hiring for a customer service coordinator role based in Albany, New York. You will manage precertification and authorization processes, handle client inquiries, and maintain positive customer relations. Candidates should have 2+ years of call-center experience, a high school diploma, and should ideally have experience in the medical or insurance fields. This opportunity emphasizes the need for strong communication and organizational skills.

Qualifications

• 2+ years of customer service call-center experience required.
• Experience in medical or insurance field preferred.
• Experience in medical or insurance field strongly preferred.
• PC proficiency.

Responsibilities

• Coordinate cases for precertification and authorization review.
• Manage incoming calls and open cases.
• Conduct clinical screening process and authorize initial sessions.
• Respond to telephone and written inquiries from clients, providers and in-house departments.
• Conduct clinical screening process. Authorize initial set of sessions to provider.
• Check benefits for facility based treatment.
• Develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

Skills

Customer service skills

PC proficiency

Medical/insurance experience

PC proficiency

Education

High school diploma or equivalent

Job description

Major Duties and Responsibilities

• Responsible for coordinating cases for precertification and prior authorization review.
• Manages incoming calls, including triage, opening of cases and authorizing sessions.
• Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
• Responds to telephone and written inquiries from clients, providers and in‑house departments.
• Conducts clinical screening process. Authorizes initial set of sessions to provider.
• Checks benefits for facility based treatment.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

Qualifications

EDUCATION / EXPERIENCE

• High school diploma or equivalent.
• Minimum of 2 years of customer service call‑center experience is required.
• Experience in medical or insurance field strongly preferred.
• PC proficiency.