Utilization Management Representative I (US)

The Utilization Management Representative I (US) coordinates cases for precertification and prior authorization review, managing incoming calls and post-service claims work. This role involves determining contract and benefit eligibility, authorizing inpatient admissions, outpatient precertifications, and post-service requests, and referring cases requiring clinical review to a Nurse reviewer. The position requires strong communication skills, attention to detail, and the ability to work in a fast-paced, high-pressure environment.