NEW JOB OPENING
UTILIZATION MANAGEMENT PHONE REPRESENTATIVE
IN Pearland, TX, USA!

Education:

• High School Diploma or equivalent



Required Qualifications

• 1–3 years of experience in healthcare, preferably in utilization management, insurance operations, or medical office settings

• Experience handling high call volumes in a professional, efficient manner

• Strong data entry and documentation skills with exceptional attention to detail

• Ability to multitask and prioritize in a fast-paced environment

• Excellent verbal and written communication skills

• Basic understanding of healthcare authorization processes

• Experience with electronic systems such as EMR/EHR or case management platforms

• Strong organizational and time management skills



Preferred Background

• Experience in managed care, health plan operations, hospitals, or physician office settings

• Familiarity with prior authorization workflows and payer/provider interactions

• Previous experience in a healthcare call center environment



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

Acting as a key liaison between providers, members, and the clinical review team, the UMR helps maintain compliance with regulatory timeframes, enhances provider satisfaction, and supports the organization’s overall care management strategy.



Key Responsibilities

• Respond to inbound calls from providers, members, and facilities regarding authorization requests, status updates, and coverage inquiries

• Create and process authorization cases from fax, electronic submissions, and phone requests

• Accurately document all authorization requests within utilization management systems or electronic health records (EHR/EMR)

• Coordinate with clinical review staff (RNs, LVNs, Medical Directors) to ensure proper routing of cases requiring medical necessity review

• Communicate authorization determinations to providers and members in accordance with regulatory and compliance standards

• Maintain high levels of accuracy while managing a high-volume workload

• Ensure adherence to turnaround times and regulatory guidelines





Team & Work Environment

You will be part of a collaborative Utilization Management team consisting of approximately 20 UMRs, alongside clinical professionals, including Registered Nurses (RNs), LVNs, and Medical Directors.

This is a fast-paced, production-driven environment where success depends on accuracy, efficiency, and teamwork. The team culture emphasizes:

• Strong collaboration and communication

• Accountability for production and quality outcomes

• Continuous learning and process improvement

• Supportive partnership with clinical and operational teams

• Commitment to compliance and high-quality member care

You will regularly interact with cross-functional teams, including clinical review, provider relations, claims, and appeals.

• **Only those lawfully authorized to work in the designated country associated with the position will be considered.**

• **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**