Utilization Management Representative III - Atlanta

Only for registered members Atlanta, United States

1 month ago

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Job summary

This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. The Utilization Management Representative III is responsible for coordinating cases for precertification and prior authorization review.

  • Responsible for providing technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services outside of initial authorized set.
  • Assisting management by identifying areas of improvement and expressing a willingness to take on new projects as assigned.
  • Handling escalated and unresolved calls from less experienced team members.
  • Sending UM Reps are directed to the appropriate resources to resolve issues.

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