Demo

Utilization Management Rep - Remote to Indiana

Professional Management Enterprises
Indianapolis, IN Remote Full Time
POSTED ON 1/14/2025 CLOSED ON 2/11/2025

What are the responsibilities and job description for the Utilization Management Rep - Remote to Indiana position at Professional Management Enterprises?

Description

We are looking for a utilization management representative to join our team. This position is a remote role but you must live within 50 miles of Indianapolis, IN to be eligible. This role is Monday - Friday 8am- 5pm EST and the pay for this role is $18.50/hr.


  • Responsible for coordinating cases for precertification and prior authorization review
  • Managing incoming calls or incoming post services claims work.
  • Determines contract and benefit eligibility
  • Provides authorization for inpatient admission, outpatient certification, and post service requests
  • Refers cases requiring clinical review to a nurse reviewer
  • Responsible for the identification and data entry of referral requests into the UM system 
  •  Responds to telephone and written inquiries from clients, providers and in-house departments
  • Other duties as assigned

Requirements

Requires:

  • HS Diploma/GED
  • Minimum 1 year of customer service experience
  • Medical terminology training and experience in the medical or insurance field is preferred
  • Needs to have strong oral, written and interpersonal communication skills, problem-solving skills, and analytical skills

Salary : $18 - $18

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