Utilization Management Representative
Kelsey-Seybold Medical Group

Job Info

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Overview

Kelsey-Seybold Clinic, a Houston tradition in patient-centered care, is a multispecialty clinic with over 25 locations and comprises more than 500 physicians providing primary and specialty care in a collaborative manner.

With 55 different clinical and non-clinical specialties, you can design a career path at Kelsey-Seybold Clinic that allows you to grow your future in a completely new direction.

Kelsey-Seybold Clinic is changing the way health cares.

Responsibilities

The Utilization Management Representative (UMR) provides office support for all units within the Utilization Management and/or Population Health Department. (Utilization Review, Concurrent Review, Population Health and Case Management.) The UMR position will assist with incoming authorization requests; data entry of clinical information, pre-certification requests. Additional responsibilities include direct communication with KSC Clinic Representatives as needed. The Utilization Management Representative is responsible for clerical support relative to the Bed Day process. Under the supervision of the Transfer Nurses, the Utilization Management Representative is primarily responsible for the collection, reporting, clarification and entry of bed day data and pre and post-acute certification requests for specific services. Under the supervision of the Health Service Supervisor, the Utilization Management Representative is primarily responsible for collection of non-clinical data, report generation, health plan coordination for non-clinical issues, and other administrative duties that are required to provide comprehensive coordination of services. Additional duties can include handling and appropriately directing referral status requests received via phone and assisting with requesting clinical updates via phone and fax from facilities. Other duties as assigned.

Qualifications

Utilization Management Representative

Location: Pearland Admin Office
Job Type: Full Time
Department: Utilization Management

EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS

(A = basics; B = preferred)



Education

A.

High school diploma or GED from an accredited program.

B.

College level courses

Experience

A.

2 -3 years of managed care experience either in a physician office or hospital setting health plan, ACO, or other managed care setting.

B.

Knowledge of CPT & ICD 10 Coding methodologies.

Licenses

A.

Valid Tx driver's license

B.

Epic System usage.

Special Skills

A.

Knowledge of medical terminology, HMO, PPO and referral processes.
Excellent communication skills
Alpha/numeric data entry and basic PC Literacy

B.

Other

A.

Excellent time management skills

B.

WORKING ENVIRONMENT

Office

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