Utilization Management Representative I

Utilization Management Representative I in a hybrid, mostly virtual call-center environment. Responsible for non-clinical outreach to members to connect them with a nurse for program enrollment and engagement, handle inbound calls, process faxes, and contact facilities to request clinical review. Duties include determining contract and program eligibility, routing calls to the appropriate team or Nurse reviewer, documenting work in systems, maintaining positive customer relations, tracking production and participating in team plans. Requires an HS diploma or GED and at least 1 year of customer service or call-center experience; role involves outbound outreach, coordination with nursing staff, and administrative tasks such as mentoring and creating job aids as part of projects. Hours typically 8:30 AM–5:00 PM Eastern with rotating evening shifts; hybrid/virtual policy allows virtual work but requires weekly in-office attendance or close proximity to posting locations for in-person training and onboarding.