Utilization Management Representative - Kelsey Seybold - Pearland

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

Benefits offered by this job

Comprehensive benefits

Incentive programs

Stock purchase plan

401k contribution

Job summary

Kelsey-Seybold Clinic, part of the Optum family, is seeking an Utilization Management Representative to provide administrative and operational support for UM and Population Health programs, including Utilization Review, Concurrent Review, Case Management, and Population Health initiatives.

This role processes authorizations, maintains records, coordinates services, and supports discharge planning, serving as a liaison between patients, providers, payers, and care teams.

Qualifications

• High School Diploma or GED from an accredited program.
• 2+ years of managed care experience in a physician office, hospital, health plan, ACO, or similar healthcare environment.
• Knowledge of medical terminology HMO, PPO, and referral processes.
• Alpha-numeric data entry and basic PC Literacy.
• Proven excellent time management skills.
• Valid Texas Driver's License.
• Experience using Epic and CPT/ICD-10 coding methodologies (preferred).

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.
• Perform other duties as assigned

Skills

Data entry

Time management

Medical terminology

Education

High School Diploma or GED

Tools

Epic

Job description

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

The Utilization Management Representative (UMR) provides administrative and operational support for Utilization Management and Population Health programs, including Utilization Review, Concurrent Review, Case Management, and Population Health initiatives. This role is responsible for processing authorization requests, maintaining accurate records, coordinating services, supporting discharge planning activities, and serving as a liaison between patients, providers, health plans, and internal care teams.

Primary 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
• Perform other duties as assigned

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma or GED from an accredited program
• 2+ years of managed care experience in a physician office, hospital, health plan, ACO, or similar healthcare environment
• Knowledge of medical terminology HMO, PPO, and referral processes
• Alpha-numeric data entry and basic PC Literacy
• Proven excellent time management skills
• Valid Texas Driver's License

Preferred Qualifications:

• Experience using Epic
• Knowledge of CPT and ICD-10 coding methodologies

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $18.00 to $32.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.