Utilization Management Representative

Pride Health is hiring a Utilization Review Specialist to support our client’s healthcare office in Pearland, TX 77584. This is a 3-month contract assignment (Possibility of extension or conversion) and a great way to start working with a top-tier healthcare organization!
 
Job Details:
Job Name: Utilization Review Specialist
Location: Pearland, TX 77584
Duration: 3+ months Contract (Possibilities of extension)
Pay rate: $13-14/hr. On W2/Pay Rate is based on experience.
Schedule: Mon to Fri (5 days/wk.) / 8 am - 5 pm (24 – 40 hrs./ wk.)

Job Responsibilities:

1. Answer provider and member calls regarding authorizations and coverage questions
2. Process and document authorization requests accurately
3. Coordinate cases with RNs, LVNs, and Medical Directors for clinical review
4. Communicate authorization determinations to providers and members
5. Maintain productivity, quality, and compliance standards.

Qualifications:

• 1–3 years of healthcare, insurance, medical office, or utilization management experience
• Strong communication, multitasking, and data entry skills
• Experience with EMR/EHR or case management systems preferred
• Ability to work in a fast-paced, team-oriented environment

Pride-Health offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance and employee discounts with preferred vendors.

Equal Employment Opportunity
Pride-Health is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Fair Chance Employment
Pride-Health is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.

Accommodations
We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us. 

Only applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.