Utilization Management Representative

We are looking for a dedicated Utilization Management Representative to join our client's team in Pearland, Texas, on a contract basis. The Utilization Management Representative position focuses on supporting the Utilization Management department by ensuring accurate and timely processing of authorization requests while maintaining clear communication with providers and members. The Utilization Management Representative role offers an opportunity to contribute to operational efficiency, regulatory compliance, and quality patient care in a health insurance environment.

Key Responsibilities:

Handle inbound calls from providers, members, and facilities regarding authorization requests, status updates, and coverage questionsReview and process authorization requests received via phone, fax, and electronic systemsCreate and document authorization cases accurately within utilization management systems or EHR platformsRoute cases requiring medical necessity review to clinical staff (RNs, LVNs, Medical Directors)Communicate authorization determinations to providers and members in compliance with regulatory requirementsMaintain accurate, timely documentation to support compliance and operational standardsCollaborate with internal teams to ensure efficient case processing and resolution