Utilization Management Services Rep I/II/III (Multiple Openings Available!)

Univera Healthcare; Buffalo (NY); Remote; USD 35,000 - 55,000; Full time

Job summary

An established industry player is seeking motivated individuals for the Utilization Management Services Rep role. This position offers a chance to provide vital administrative support while delivering exceptional customer service. You'll be the primary contact for authorization requests, ensuring compliance with regulatory requirements. With opportunities for growth into project management and training roles, this position is ideal for those looking to advance in the healthcare sector. Join a diverse and compassionate team that values excellence and innovation, and enjoy the flexibility of potential remote work.

Qualifications

• High School Diploma or GED required.
• Strong analytical, communication, and organizational skills needed.
• Call center experience preferred.

Responsibilities

• Facilitating inbound and outbound calls to members and providers.
• Responding to customer inquiries and promoting acceptance of services.
• Processing authorization requests and maintaining member privacy.

Skills

Analytical Skills

Communication Skills

Organizational Skills

Customer Service

Self-motivation

Education

High School Diploma or GED

Tools

Microsoft Office

Job description

Join to apply for the Utilization Management Services Rep I/II/III (Multiple Openings Available!) role at Univera Healthcare

This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. It acts as a resource for both internal and external customers through completing timely and accurate inbound and/or outbound calls, creating authorizations via phone, Care Advance Provider Tool, and fax for inpatient and outpatient procedures, behavioral health, and durable medical equipment.

Responsibilities include:

• Facilitating inbound and outbound calls to members and providers, delivering excellent customer service.
• Responding professionally and efficiently to customer inquiries to promote acceptance of services and policies.
• Performing triage for UM Services.
• Serving as the primary contact for provider authorization requests.
• Communicating regulatory requirements to members and providers, including DOH notifications and NCQA guidelines.
• Providing timely and accurate research responses to other departments.
• Processing fax requests from designated queues.
• Upholding high standards of integrity, supporting company values, and maintaining member privacy.
• Ensuring consistent attendance and performing additional duties as assigned.

Levels II and III have additional responsibilities, including project management, training, complex issue resolution, and supporting leadership.

Minimum qualifications include:

• High School Diploma or GED.
• Experience with desktop computers and Microsoft Office.
• Call center experience preferred but not required.
• Strong analytical, communication, and organizational skills.
• Self-motivated and capable of working independently and in teams.

Higher levels require specific healthcare industry experience and operational knowledge, including familiarity with managed care, FACETS application, and complex regulatory rules.

Physical requirements include prolonged sitting, working in a home office, and travel as needed.

We value diversity and encourage underrepresented groups to apply. Our culture emphasizes compassion, pride, excellence, innovation, and fun. Compensation varies by level, with remote work possible depending on circumstances.