Utilization Management Representative - Hybrid-Kelsey Seybold Pearland TX

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40 locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.  

The Utilization Management Representative (UMR) provides office support for all units within the Utilization Management and/or Population Health Department. (Utilization Review, Concurrent Review, Population Health and Case Management.)   The UMR position will assist with incoming authorization requests; data entry of clinical information, pre-certification requests.   Additional responsibilities include direct communication with KSC Clinic Representatives as needed.  The Utilization Management Representative is responsible for clerical support relative to the Bed Day process. Under the supervision of the Transfer Nurses, the Utilization Management Representative is primarily responsible for the collection, reporting, clarification and entry of bed day data and pre and post-acute certification requests for specific services.  Under the supervision of the Health Service Supervisor, the Utilization Management Representative is primarily responsible for collection of non-clinical data, report generation, health plan coordination for non-clinical issues, and other administrative duties that are required to provide comprehensive coordination of services.  Additional duties can include handling and appropriately directing referral status requests received via phone and assisting with requesting clinical updates via phone and fax from facilities.   Other duties as assigned.  

Primary Responsibilities:

• Data entry of UR and/or Pop Health requests, admissions and discharge dates for inpatient services; address post-acute discharge needs into EPIC.  Address into the system including pre cert for OB patients
• Completion of clerical support tasks including incoming and outgoing fax requests, Xeroxing and filing, general mail support and correspondence received.  Generate reports for specific tasks (i.e. bed day.)
• Collaborates with external and internal customers to coordinate delivery of services and discharge planning as needed.  Including but not limited to making appointments, contacting patients regarding various issues, coordinating services between providers, payers and patients
• Obtain authorizations from health plan for POS internal referrals and other services
• Verifies benefit interpretation and other communication from payors are entered into Kelsey-Seybold system
• Serves as resource to clinic physicians, staff, payors and patients regarding pre-certification issues
• Other duties as assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School diploma or GED from an accredited program
• 2 years of managed care experience either in a physician office or hospital setting health plan, ACO, or other managed care setting
• Knowledge of medical terminology, HMO, PPO and referral processes
• Proven excellent communication skills
• Alpha/numeric data entry and basic PC Literacy
• Proven excellent time management skills  
• Valid Texas driver's license

Preferred Qualifications:

• College level courses
• Knowledge of CPT & ICD 10 Coding methodologies
• Epic System usage

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $18 - $32 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment. 

Salary : $18 - $32