Utilization Management Clerk

Pineland BHDD is seeking a detail-oriented Utilization Management Clerk to support our Behavioral Health and Substance Use Disorder programs. This role is essential in ensuring timely authorizations, accurate documentation, and effective communication with insurance providers, staff, and external partners to help individuals access the services they need.

The Utilization Management Clerk performs a variety of administrative and clerical functions related to insurance authorizations, utilization management, reporting, and recordkeeping. This position serves as a key support role in maintaining compliance, tracking authorizations, and ensuring accurate data management across programs.

What You'll Do

Authorization & Utilization Management

• Verify insurance coverage and understand payer requirements
• Submit and document authorizations daily
• Review and enter approved authorizations from external agencies
• Monitor authorizations for accuracy and resolve errors when identified
• Track authorization status and maintain accurate records of approvals and renewals

Administrative Support

• Maintain organized filing and recordkeeping systems
• Perform data entry and database maintenance
• Prepare reports, memoranda, and other administrative documents
• Manage financial and utilization-related reports
• Support departmental operations through clerical and administrative assistance

Communication & Collaboration

• Communicate effectively with staff, providers, and external agencies via phone and email
• Provide timely updates regarding authorization status and documentation needs
• Work collaboratively with team members to support program goals and compliance efforts

Required Qualifications

• High School Diploma or GED
• Minimum of one (1) year of administrative or clerical experience

Preferred Qualifications

• Experience in healthcare, behavioral health, insurance verification, or utilization management
• Familiarity with CareLogic or other electronic health record systems
• Experience working with insurance authorizations and payer requirements

Skills That Lead to Success

• Strong organizational and time-management skills
• Attention to detail and data accuracy
• Effective verbal and written communication skills
• Ability to multitask and manage deadlines in a fast-paced environment
• Proficiency with: Microsoft Word, Microsoft Excel, and Email communication
• Electronic health record systems such as CareLogic
• Ability to work independently while maintaining a collaborative team approach

Additional Information

• Office-based position with occasional travel as needed
• Standard business office environment
• Drug-free workplace (pre-employment screening required)

Pineland BHDD is proud to be an Equal Employment Opportunity (EEO) Employer.

Apply today and help ensure individuals receive the services they need through accurate, timely, and efficient utilization management support.

Job Type: Full-time

Pay: From $36,000.00 per year

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Vision insurance

Application Question(s):

• Do you have any family members working for Pineland BHDD?
• Have you or someone you know previously or currently received services at Pineland?

Education:

• High school or equivalent (Required)

Experience:

• medical administrative support: 1 year (Preferred)
• Insurance verification: 1 year (Preferred)
• Clerical: 1 year (Preferred)

Ability to Commute:

• Statesboro, GA 30458 (Required)

Work Location: In person

Salary : $36,000