Utilization Management Representative I

Anticipated End Date: 2026-11-02 Position Title: Utilization Management Representative I Job Description: Utilization Management Representative I Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. How you will make an impact: - Managing incoming calls or incoming post services claims work. - Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, 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 in accordance with the plan certificate. - Responds to telephone and written inquiries from clients, providers and in-house departments. - Conducts clinical screening process. - Authorizes initial set of sessions to provider. - Checks benefits for facility based treatment. - Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner. - Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers. - Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment. - Strong verbal and written communication skills, both with virtual and in-person interactions. - Attentive to details, critical thinker