Utilization Management Representative I - Costa Mesa
1 month ago

Job summary
This role enables associates to work virtually full-time with maximum flexibility and autonomy. The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review.Responsibilities
- 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.
Job description
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