Sign upLog in

Utilization Management Phone Representative Jobs in USA, TX, Pearland | Rose International Job

Rose International

Pearland, TX

Apply
JOB DETAILS
SALARY
$14–$14 Per Hour
JOB TYPE
Temporary
SKILLS
Call Center Management, Call Volume, Case Management, Clinical Support, Communication Skills, Cross-Functional, Data Entry, Detail Oriented, Documentation, Electronic Medical Records, Establish Priorities, Health Plan, Healthcare, High School Diploma, Hospital, Insurance, Maintain Compliance, Managed Care, Management Strategy, Medical Office, Medical Record System, Multitasking, Operational Strategy, Operations Planning, Organizational Skills, Patient Care, Patient Care Authorizations, Performance Reviews, Presentation/Verbal Skills, Process Development, Process Improvement, Production Systems, Provider Relations, Registered Nurse (RN), Regulations, Regulatory Compliance, Team Player, Telephone Skills, Time Management, Utilization Management, Writing Skills
LOCATION
Pearland, TX
POSTED
6 days ago
Education: High School Diploma or equivalentRequired Qualifications 1–3 years of experience in healthcare, preferably in utilization management, insurance operations, or medical office settings Experience handling high call volumes in a professional, efficient manner Strong data entry and documentation skills with exceptional attention to detail Ability to multitask and prioritize in a fast-paced environment Excellent verbal and written communication skills Basic understanding of healthcare authorization processes Experience with electronic systems such as EMR/EHR or case management platforms Strong organizational and time management skillsPreferred Background Experience in managed care, health plan operations, hospitals, or physician office settings Familiarity with prior authorization workflows and payer/provider interactions Previous experience in a healthcare call center environmentThe Utilization Management Representative (UMR) plays a vital role in supporting the Utilization Management department by ensuring the timely and accurate processing of authorization requests and communicating determinations to providers and members. This position directly contributes to regulatory compliance, operational efficiency, and quality patient care by facilitating the appropriate use of healthcare services.Acting as a key liaison between providers, members, and the clinical review team, the UMR helps maintain compliance with regulatory timeframes, enhances provider satisfaction, and supports the organization’s overall care management strategy.Key Responsibilities Respond to inbound calls from providers, members, and facilities regarding authorization requests, status updates, and coverage inquiries Create and process authorization cases from fax, electronic submissions, and phone requests Accurately document all authorization requests within utilization management systems or electronic health records (EHR/EMR) Coordinate with clinical review staff (RNs, LVNs, Medical Directors) to ensure proper routing of cases requiring medical necessity review Communicate authorization determinations to providers and members in accordance with regulatory and compliance standards Maintain high levels of accuracy while managing a high-volume workload Ensure adherence to turnaround times and regulatory guidelinesTeam & Work EnvironmentYou will be part of a collaborative Utilization Management team consisting of approximately 20 UMRs, alongside clinical professionals, including Registered Nurses (RNs), LVNs, and Medical Directors.This is a fast-paced, production-driven environment where success depends on accuracy, efficiency, and teamwork. The team culture emphasizes: Strong collaboration and communication Accountability for production and quality outcomes Continuous learning and process improvement Supportive partnership with clinical and operational teams Commitment to compliance and high-quality member care You will regularly interact with cross-functional teams, including clinical review, provider relations, claims, and appeals. **Only those lawfully authorized to work in the designated country associated with the position will be considered.** **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.** Benefits: For information and details on employment benefits offered with this position, please visit here. Should you have any questions/concerns, please contact our HR Department via our secure website. California Pay Equity: For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here. Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances. If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department. Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.).

About the Company

R

Rose International

Founded in 1993 by Sue Bhatia, Rose International is one of the nation's leading minority- and woman-owned providers of Staffing and Total Talent Solutions. We serve companies in all 50 states and employ thousands of people across the country.

COMPANY SIZE
2,500 to 4,999 employees
INDUSTRY
Staffing/Employment Agencies
WEBSITE
https://www.roseint.com/