Utilization Management Specialist – Authorizations & Care

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

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.