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Utilization Management Rep - Remote to Indiana at Professional Management Enterprises

Indianapolis, Indiana, United States -

Full Time

Start Date

Immediate

Expiry Date

17 Dec, 25

Salary

18.5

Posted On

18 Sep, 25

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Customer Service, Medical Terminology, Communication Skills, Problem-Solving Skills, Analytical Skills

Industry

Professional Services

Description

Description We are looking for a utilization management representative to join our team. This position is a remote role but you must live within 50 miles of Indianapolis, IN to be eligible. This role is Monday - Friday 8am- 5pm EST and the pay for this role is $18.50/hr. Responsible for coordinating cases for precertification and prior authorization review Managing incoming calls or incoming post services claims work. Determines contract and benefit eligibility Provides authorization for inpatient admission, outpatient certification, and post service requests Refers cases requiring clinical review to a nurse reviewer Responsible for the identification and data entry of referral requests into the UM system Responds to telephone and written inquiries from clients, providers and in-house departments Other duties as assigned Requirements Requires: HS Diploma/GED Minimum 1 year of customer service experience Medical terminology training and experience in the medical or insurance field is preferred Needs to have strong oral, written and interpersonal communication skills, problem-solving skills, and analytical skills

Responsibilities

The Utilization Management Representative is responsible for coordinating cases for precertification and prior authorization review. This includes managing incoming calls, determining contract and benefit eligibility, and providing authorization for various services.