Utilization Management Representative - Kelsey Seybold Clinic - Pearland, TX

Requisition Number: 2351562
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.
Primary Responsibilities:

• Provides office support for all units within the Utilization Management and/or Population Health Department. (Utilization Review, Concurrent Review, Population Health and Case Management.)
• Assist with incoming authorization requests; data entry of clinical information, pre-certification requests
• Direct communication with KSC Clinic Representatives as needed
• 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

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
• Proven knowledge of medical terminology, HMO, PPO and referral processes
• Proven excellent communication skills
• Demonstrated alpha/numeric data entry and basic PC literacy
• Valid Texas driver's license

Preferred Qualifications:

• Proven knowledge of CPT & ICD 10 Coding methodologies
• Epic System usage experience

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 $16.15 to $28.80 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 make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
OptumCare is 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.