<p>We are looking for a dedicated <strong>Utilization Management Representative</strong> to join our client&#39;s team in Pearland, Texas, on a contract basis. The<strong> Utilization Management Representative</strong> position focuses on supporting the Utilization Management department by ensuring accurate and timely processing of authorization requests while maintaining clear communication with providers and members. The <strong>Utilization Management Representative</strong> role offers an opportunity to contribute to operational efficiency, regulatory compliance, and quality patient care in a health insurance environment.</p><p><br></p><p><strong>Key Responsibilities:</strong></p><ul><li>Handle inbound calls from providers, members, and facilities regarding authorization requests, status updates, and coverage questions</li><li>Review and process authorization requests received via phone, fax, and electronic systems</li><li>Create and document authorization cases accurately within utilization management systems or EHR platforms</li><li>Route cases requiring medical necessity review to clinical staff (RNs, LVNs, Medical Directors)</li><li>Communicate authorization determinations to providers and members in compliance with regulatory requirements</li><li>Maintain accurate, timely documentation to support compliance and operational standards</li><li>Collaborate with internal teams to ensure efficient case processing and resolution</li></ul><p><br></p>

<p><strong>Ideal Candidate Background:</strong></p><ul><li>Experience in healthcare operations, managed care, or utilization management</li><li>Background supporting authorization processes and working with providers</li><li>Experience in health plans, medical offices, hospitals, or healthcare call centers preferred</li><li>Familiarity with EMR/EHR systems and healthcare workflows</li></ul><p>•<strong>Required Skills &amp; Qualifications:</strong></p><ul><li>1–3 years of healthcare experience (utilization management, insurance operations, or medical office preferred)</li><li>Experience handling high call volumes in a professional environment</li><li>Strong data entry and documentation accuracy</li><li>Ability to multitask in a fast-paced setting</li><li>Effective communication skills with providers, members, and internal teams</li><li>Basic understanding of authorization processes in healthcare or insurance</li><li>Experience with EMR/EHR or case management systems</li><li>Strong organizational and time management skills</li></ul>

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