Job Description

Job Title: Utilization Management Representative (UMR)

Work Location: 11511 Shadow Creek Parkway
Schedule: Monday – Friday | 8:00 AM – 5:00 PM | 24–40 hours per week
Interview Process: Virtual interview via camera
Dress Code: Business Casual
Pay Rate: 13/hr (Paid Weekly)
Allmed Benefits: Vision, Health, Dental Insurance & 401(k)

Position

The Utilization Management Representative (UMR) plays a critical role in supporting Utilization Management operations by ensuring the timely and accurate processing of authorization requests and communicating authorization determinations to providers and members. This role directly supports regulatory compliance, operational efficiency, and quality patient care by facilitating appropriate utilization of healthcare services.

The UMR serves as a key point of contact between providers, members, and the clinical review team while supporting overall care management strategies through efficient workflow management and effective communication.

Team Environment

The selected candidate will join a collaborative Utilization Management team consisting of approximately 20 Utilization Management Representatives (UMRs) working alongside clinical reviewers, including Registered Nurses (RNs), LVNs, and Medical Directors.

The team operates in a fast-paced, production-driven environment where accuracy, efficiency, and teamwork are critical to success. Team culture emphasizes:

• Collaboration and strong communication
• Accountability for productivity and quality metrics
• Continuous learning and process improvement
• Supportive teamwork across clinical and operational departments
• Commitment to regulatory compliance and quality member care

Team members regularly collaborate with internal departments including clinical review teams, provider relations, claims, and appeals teams.

Key Responsibilities

• Answer inbound calls from providers, members, and healthcare facilities regarding authorization requests, status updates, and coverage questions
• Create authorization cases by reviewing and processing clinical requests received through fax, electronic submissions, or phone communication
• Accurately document authorization requests within utilization management systems and/or electronic medical record systems
• Coordinate with clinical review staff, including RNs, LVNs, and Medical Directors, to appropriately route cases requiring medical necessity review
• Communicate authorization determinations verbally to providers and members in compliance with regulatory guidelines and organizational requirements
• Maintain accurate records and ensure documentation standards are consistently met
• Support workflow efficiency while managing multiple priorities in a high-volume environment
• Provide exceptional customer service while maintaining confidentiality and professionalism

Required Qualifications

• 1–3 years of healthcare experience, preferably within:
  • Utilization Management
  • Insurance operations
  • Medical office environments
  • Managed care settings
• Experience handling high-volume calls in a professional and efficient manner
• Strong data entry and documentation skills with high attention to detail
• Ability to effectively manage multiple tasks simultaneously in a fast-paced environment
• Strong verbal and written communication skills when interacting with providers, members, and internal teams
• Basic understanding of healthcare authorization processes and insurance workflows
• Experience using EMR/EHR platforms, case management systems, or related healthcare systems
• Strong organizational and time-management skills

Preferred Qualifications

• Experience supporting authorization processes within healthcare operations or managed care settings
• Previous experience in health plans, hospitals, medical offices, or healthcare call center environments
• Experience working with provider communication and care coordination activities
  
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