CrawlJobs Logo
Robert Half Logo Robert Half · Call Center

Utilization Management Representative

United States, Pearland · Job Posted May 27, 2026
Apply Position
Job Link Share

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
Robert Half - All Job Offers

Looking for more opportunities?

Search for other job offers that match your skills and interests.

Suggested Tags: Frontend Developer Secretary Talent Manager Salesforce Administrator Data Analyst
Similar Jobs for

Utilization Management Representative

8 matching positions

Construction Management Representative

The Construction Management Representative (CMR) provides on-site construction o...
Location
Location
United States , Browning, MT
Salary
Salary:
Not provided
bodwegroup.com Logo
Bodwé Professional Services
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's Degree with minimum 5 years of experience in construction, engineering, and/or water and wastewater utilities
  • Demonstrated federal project experience (required)
  • OSHA 30-hour Construction Safety certification
  • Strong knowledge of: Waterline trenching and water utility systems
  • Electrical generator installation and operation
  • SCADA systems
  • Compaction testing and construction techniques
  • Applicable industry standards, regulations, and codes
  • Cost breakdown estimating and negotiations
  • Technical writing
Job Responsibility
Job Responsibility
  • On-Site Construction Oversight
  • Safety Compliance
  • Documentation & Contract Administration
  • Communications
  • Meetings & Reporting
  • Fulltime
Read More
Arrow Right

Registration and insurance management representative iii

As a community, the University of Rochester is defined by a deep commitment to M...
Location
Location
United States of America , Albany
Salary
Salary:
19.62 - 26.49 USD / Hour
urmc.rochester.edu Logo
University of Rochester
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • High School diploma or equivalent and 4 years of experience in patient accounts related area required
  • Bachelor's degree preferred
  • Or equivalent combination of education and experience
Job Responsibility
Job Responsibility
  • Performs the functions of patient account management for individuals receiving services
  • Completes the tasks of insurance verification, obtaining precertification, completing credit statements, making payments plans, requesting deposits, initiating referrals to sponsorship programs
  • Coordinates account management through discharge and forwards accounts to the patient accounting office
  • Initiates appropriate contact with third-party payors to verify insurance benefits of patients
  • Documents information in an accurate and timely manner in the hospital computer system
  • Maintains a monitoring system of benefits throughout all inpatient stays
  • Obtains any signatures required to obtain verification and secure benefits
  • Informs patients of hospital financial policies
  • Establishes payment plans for patients according to these policies using results of credit statements
  • Assists patients in identifying resources to be used to meet their hospital obligation
  • Fulltime
Read More
Arrow Right

Registration and insurance management representative iii

As a community, the University of Rochester is defined by a deep commitment to M...
Location
Location
United States of America , Rochester
Salary
Salary:
19.62 - 26.49 USD / Hour
urmc.rochester.edu Logo
University of Rochester
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • High School diploma or equivalent and 4 years of experience in patient accounts related area required
  • Bachelor's degree preferred
  • Or equivalent combination of education and experience
Job Responsibility
Job Responsibility
  • Performs the functions of patient account management for individuals receiving services
  • Completes the tasks of insurance verification, obtaining precertification, completing credit statements, making payments plans, requesting deposits, initiating referrals to sponsorship programs
  • Coordinates account management through discharge and forwards accounts to the patient accounting office
  • Initiates appropriate contact with third-party payors to verify insurance benefits of patients
  • Documents information in an accurate and timely manner in the hospital computer system
  • Maintains a monitoring system of benefits throughout all inpatient stays
  • Obtains any signatures required to obtain verification and secure benefits
  • Informs patients of hospital financial policies
  • Establishes payment plans for patients according to these policies using results of credit statements
  • Assists patients in identifying resources to be used to meet their hospital obligation
  • Fulltime
Read More
Arrow Right

Customer Service Representative - Order Management

As a true pillar of trust, you will bridge the gap between clients, the sales te...
Location
Location
Canada , Vaudreuil-Dorion
Salary
Salary:
25.00 - 28.00 CAD / Hour
https://www.randstad.com Logo
Randstad
Expiration Date
August 21, 2026
Flip Icon
Requirements
Requirements
  • 1 to 2 years of experience in a customer service or logistics coordination role within a manufacturing or industrial distribution environment
  • Full professional fluency in both French and English (written and spoken)
  • Strong computer literacy, specifically with the Microsoft Office Suite
  • Practical knowledge or previous experience utilizing Epicor ERP software is considered a significant asset
  • Highly organized, proactive mindset with a strong sense of initiative, and the ability to comfortably manage a fluctuating daily workload (ranging from 2 to 50 orders per day)
  • Perfect bilingualism (French/English) is a mandatory requirement for this role
Job Responsibility
Job Responsibility
  • Managing and resolving customer inquiries received primarily via email as well as over the phone
  • Reviewing customer requests to prepare and deliver commercial quotes and pricing estimates in a timely fashion
  • Processing and entering customer orders accurately into the company's centralized management system
  • Collaborating daily with the purchasing department to verify inventory levels and coordinate incoming weekly stock
  • Monitoring freight shipments and tracking deliveries with carriers to proactively keep customers updated on their order status
  • Handling administrative support duties, including document management and systematic client file organization
What we offer
What we offer
  • Competitive Compensation: Hourly wage established between $25.00 and $28.00 / hour, commensurate with experience
  • Path to Permanency: Guaranteed minimum 3-month temporary assignment (medical leave coverage) with a very high probability of transitioning into a permanent hire
  • Stable Work Schedule: 37.5 hours per week, Monday through Friday, promoting an excellent work-life balance
  • Welcoming Work Culture: Join an established team of 13 local employees where low turnover reflects a genuinely supportive and collaborative work environment
  • Structured Onboarding: Benefit from a comprehensive 2-week hands-on training program directly guided by a senior team member
  • Geographic Stability: Position based 100% on-site within modern commercial offices in Vaudreuil
  • Fulltime
Read More
Arrow Right
New

Sr Facilities Engineer (Mechanical)

Proven to Perform. From the edges of space to the bottoms of ocean, our material...
Location
Location
United States , Cudahy
Salary
Salary:
Not provided
atimaterials.com Logo
ATI
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor of Science Degree in Engineering or Science, or State registration in lieu of Degree
  • 5+ years experience in area of Design
  • Apply software to enhance job performance (i.e. Autocad Inventor, MS Project, Excel, Word, FEA)
  • Must demonstrate good judgement in evaluation, selection, and modification and adoption of engineering techniques and procedures
  • Must demonstrate originality and ingenuity in solution of engineering problems
  • Is expected to carry out specific job assignments with only a definition of objectives and with minimum of technical supervision
  • Must possess a high degree of awareness of responsibility, cost, productivity, and manufacturability
Job Responsibility
Job Responsibility
  • Makes design layouts utilizing the principles of complex stress analysis, mechanics, kinematics, machine and tool design, strength of materials, physics, mathematics, and other physical sciences to a high degree
  • Makes complex assembly and complex detail drawings, prepares bills of material, specification sheets, procedures, instructions, or any other required technical data
  • Studies new projects and investigates any questions concerning machinery, tools, processes, equipment, buildings, or facilities and recommend redesign, repair or rebuilding to overcome difficulties, correct improper function, or meet requirements
  • Initiate action regarding methods or procedures in developmental or experimental work
  • Work with other engineers, designers, and/or representatives of other departments on matters involving requirements or performance of tools, machines, equipment, buildings, or facilities
  • Maintain job working records and prepare reports and correspondence
  • Is expected to be able to direct technical work of a group or technicians, draftsmen, and/or Engineers
  • Manages medium sized projects including design, tooling, purchasing, installation, and startup
  • Performs other related duties and responsibilities
  • Fulltime
Read More
Arrow Right

Assistant Store Manager

Join our fashion-obsessed team, dedicated to a styling and social experience tha...
Location
Location
United States , Allen
Salary
Salary:
Not provided
chicos.com Logo
Chico's FAS, Inc.
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • High School diploma or equivalent
  • 2+ years of retail management experience preferred
  • Must be 18 years of age or older
  • Excellent communication, verbal, and written skills
  • Able to learn or adapt to technology provided by the company
  • Proven excellent customer service skills with statistical track record in all areas of sales and leadership
  • Strong organizational skills and ability to multi-task in a fast-paced environment
  • Strong leadership qualities, training and team building skills
  • Knowledge of administrative aspects of store operations
  • Able to communicate with customers and staff
Job Responsibility
Job Responsibility
  • Analyzes sales reports and KPIs to determine the needs of the business
  • In partnership with Store Manager, executes in store business and sales strategies
  • Establishes and communicates clear expectations, holding store team and themselves accountable for achieving all brand, performance, and behavior standards
  • Controls payroll and supply budget
  • Performs and oversees basic operational activities such as scheduling, target shrink audits, physical inventory, opening and closing duties, time sheet review and payroll accuracy documents, and merchandise flow processes
  • Performs all financial activities effectively and in accordance with policy, including cash handling and reporting, price changes, and merchandise handling
  • ensures all register transactions are completed accurately and in accordance with policy
  • Ensures compliance with all applicable laws, loss prevention policies, operating procedures and controls
  • conducts associate training to reinforce proper controls
  • Administers all operational process including inventory receipt/dispatch, daily replenishment of floor merchandise levels, and execution and preparation of physical inventories
  • Fulltime
Read More
Arrow Right

Human Resources Shared Services Specialist II - HR Shared Services

The Human Resources Shared Services Specialist II performs all duties of the Spe...
Location
Location
United States , Irving
Salary
Salary:
Not provided
christushealth.org Logo
CHRISTUS Health
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • High School Diploma required
  • 1-3 years of experience in Human Resources, Shared Services, or Payroll required
  • Ability to effectively and professionally communicate with all levels of the organization verbally and in writing
  • Excellent organizational skills and ability to manage multiple priorities effectively
  • Proficiency in Infor, ServiceNow, and Avaya
  • Critical thinking and problem-solving skills
Job Responsibility
Job Responsibility
  • Provides accurate and efficient resolution of issues and inquiries through multiple channels (phone, email, Service Now) by following appropriate resolution/assessment methodology (investigating and research), utilizing knowledge management tools, educating customers on products and self-service tools, and determining the appropriate course of action or escalation for emerging issues
  • Provides initial contact and support for customers dealing with sensitive and confidential information relating to HR issues
  • Interacts with customers via telephone and chat to answer questions and aids in the completion of human resource transactions
  • Inputs, updates, and/or retrieves information from human resource or payroll systems
  • Documents all contacts and outcomes within the center’s case management software application
  • Routes calls to appropriate staff and/or office
  • Assists less experienced representatives, as necessary
  • Explains work instructions to others, adapting guidelines to the assignments as necessary
  • Trains lower-level Human Resources Customer Service Representatives
  • Performs related work as assigned
  • Fulltime
Read More
Arrow Right

Budget Analyst

We are looking for a Budget Analyst to support financial planning and oversight ...
Location
Location
United States , Baltimore
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 5+ years of experience in budgeting, budget analysis, or financial management
  • Strong knowledge of annual budget preparation, expenditure monitoring, variance analysis, and budget control practices
  • Working understanding of accounting principles, including journal entries, account reconciliation, month-end activities, and accounts payable processes
  • Advanced proficiency with Microsoft Excel and solid experience using PC-based financial and reporting tools
  • Ability to interpret policies, funding rules, and program regulations within a public sector, housing, or similarly regulated environment
  • Proven skill in preparing clear financial reports, budget narratives, and supporting documentation for management review
  • Experience reviewing financial transactions for accuracy, funding availability, and compliance with approved budgets
  • Strong written and verbal communication skills with the ability to present financial information clearly and build effective working relationships
Job Responsibility
Job Responsibility
  • Develop annual operating and program budgets by gathering data, organizing review materials, coordinating discussions with business units, and consolidating final budget submissions
  • Track financial activity across departmental, grant-funded, and housing-related programs to ensure expenditures align with approved funding and operational goals
  • Evaluate budget performance through variance reviews, utilization trends, vacancy metrics, and other financial indicators, then communicate findings and recommended actions
  • Prepare budget revisions, journal entries, reconciliations, and supporting analysis to maintain accurate financial records and reflect changing program needs
  • Review requisitions, invoices, and personnel-related funding documents to confirm proper account charging, available budget capacity, and adherence to guidelines
  • Produce budget narratives, financial summaries, charts, and formal reports for leadership and external stakeholders, including required compliance documentation
  • Analyze program performance measures and assist teams in aligning operational targets with budget assumptions and financial results
  • Forecast the financial position of assigned programs and identify risks, cost pressures, or funding gaps that may affect ongoing operations
  • Represent the budget function in meetings, respond to budget-related inquiries, and complete special financial analysis projects as assigned
What we offer
What we offer
  • Medical insurance
  • Vision insurance
  • Dental insurance
  • Life insurance
  • Disability insurance
  • 401(k) plan
  • Fulltime
Read More
Arrow Right