Utilization Management Representative

At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly.

SUMMARY
·         Responsible for coordinating cases for precertification and prior authorization review.

MAJOR JOB DUTIES AND RESPONSIBILITIES: Primary duties may includes, but are not limited:
·         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.
·         Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
·         Responds to telephone and written inquiries from clients, providers and in-house departments.
·         Conducts clinical screening process.
·         Authorizes initial set of sessions to provider.
·         Checks benefits for facility based treatment.
·         Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

EDUCATION/EXPERIENCE
·         Requires High school diploma
·         1 year of customer service or call-center experience; proficient analytical, written and oral communication skills; or any combination of education and experience, which would provide an equivalent background.
·         Medical terminology training and experience in medical or insurance field preferred.

Required education: HS Diploma

Top 3 Must-Haves:

1. Call Center

2. Medical terminology

3. Good Tenure

Why Kelly?

As a Kelly Services candidate you will have access to numerous perks, including:

Exposure to a variety of career opportunities as a result of our expansive network of client companies 

Career guides, information and tools to help you successfully position yourself throughout every stage of your career

Access to more than 3,000 online training courses through our Kelly Learning Center

Group-rate insurance options available immediately upon hire*

Weekly pay and service bonus plans