Utilization Management Rep

Answer inbound calls from providers, members, and healthcare facilities regarding authorization requests, status updates, and coverage questions. Create authorization cases by reviewing and processing clinical requests received through fax, electronic submissions, or phone communication. Accurately document authorization requests within utilization management systems and coordinate with clinical review staff, including RNs, LVNs, and Medical Directors, to appropriately route cases requiring medical necessity review. Communicate authorization determinations verbally to providers and members in compliance with regulatory guidelines. Maintain accurate records, ensure documentation standards are met, and support workflow efficiency while managing multiple priorities in a high-volume environment. Join a collaborative team of approximately 20 Utilization Management Representatives working alongside clinical reviewers to support regulatory compliance and quality patient care.