Utilization Management Representative I - Costa Mesa

Only for registered members Costa Mesa, United States

1 month ago

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$17.87 - $27.97 (USD)

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.

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