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Robert Half Logo Robert Half · Call Center

Utilization Management Representative

United States, Pearland · Job Posted May 27, 2026
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Job Description

We are looking for a dedicated Utilization Management Representative to join our client's team in Pearland, Texas, on a contract basis. The Utilization Management Representative position focuses on supporting the Utilization Management department by ensuring accurate and timely processing of authorization requests while maintaining clear communication with providers and members. The Utilization Management Representative role offers an opportunity to contribute to operational efficiency, regulatory compliance, and quality patient care in a health insurance environment.

Job Responsibility

  • Handle inbound calls from providers, members, and facilities regarding authorization requests, status updates, and coverage questions
  • Review and process authorization requests received via phone, fax, and electronic systems
  • Create and document authorization cases accurately within utilization management systems or EHR platforms
  • Route cases requiring medical necessity review to clinical staff (RNs, LVNs, Medical Directors)
  • Communicate authorization determinations to providers and members in compliance with regulatory requirements
  • Maintain accurate, timely documentation to support compliance and operational standards
  • Collaborate with internal teams to ensure efficient case processing and resolution

Requirements

  • 1–3 years of healthcare experience (utilization management, insurance operations, or medical office preferred)
  • Experience handling high call volumes in a professional environment
  • Strong data entry and documentation accuracy
  • Ability to multitask in a fast-paced setting
  • Effective communication skills with providers, members, and internal teams
  • Basic understanding of authorization processes in healthcare or insurance
  • Experience with EMR/EHR or case management systems
  • Strong organizational and time management skills

Nice to have

  • Experience in healthcare operations, managed care, or utilization management
  • Background supporting authorization processes and working with providers
  • Experience in health plans, medical offices, hospitals, or healthcare call centers preferred
  • Familiarity with EMR/EHR systems and healthcare workflows

What we offer

  • medical
  • vision
  • dental
  • life and disability insurance
  • 401(k) plan
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