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Utilization Management Rep Jobs (NOW HIRING)

Elevance Health

Utilization Management Rep I

Utilization Management Rep I Utilization Management Representative I Shift: Monday-Friday Location: Virtual: This role enables associates to work virtually full-time, except for required in-person ...

Elevance Health

Utilization Management Rep I

Atlanta, GA · On-site

$15.96 - $18/hr

Utilization Management Rep I Utilization Management Representative I Shift: Monday-Friday (Must be willing to work weekends and holidays) Location: Virtual: This role enables associates to work ...

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How much do utilization management rep jobs pay per hour?

As of Aug 26, 2026, the average hourly pay for utilization management rep in the United States is $31.94, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $40.62 per hour, depending on experience, location, and employer.

What is a utilization management rep?

A Utilization Management Representative, often called a UM Rep, is a professional who reviews medical service requests to ensure that treatments and procedures are medically necessary and covered by a patient's insurance plan. They work with healthcare providers, insurance companies, and patients to review clinical information, authorize care, and sometimes suggest alternative treatments based on policy guidelines. UM Reps play a key role in managing healthcare costs while maintaining quality care by adhering to established criteria and regulations.

What are the key skills and qualifications needed to thrive as a utilization management rep?

To thrive as a Utilization Management Representative, you need a solid understanding of healthcare policies, medical terminology, and insurance processes, typically supported by a background in healthcare administration or a related field. Familiarity with utilization review software, electronic medical records (EMR), and claims management systems is typically required. Strong attention to detail, effective communication, and customer service skills help you excel when coordinating between providers, members, and insurance teams. These competencies ensure accurate case review, regulatory compliance, and positive patient outcomes in a complex healthcare environment.

How does a utilization management rep collaborate with healthcare providers and internal teams to ensure appropriate patient care?

A Utilization Management Rep frequently interacts with healthcare providers, such as physicians and nurses, to gather clinical information and clarify treatment plans. They also work closely with internal medical directors, case managers, and claims teams to review authorization requests and determine medical necessity based on established guidelines. Effective communication and teamwork are key, as the role requires balancing patient needs, provider requests, and payer policies to facilitate timely, appropriate care decisions. This collaboration ensures that patients receive necessary services while helping to control healthcare costs.

What is the difference between Utilization Management Rep vs Utilization Review Coordinator?

AspectUtilization Management RepUtilization Review Coordinator
CertificationsCPUR, RHIT, or similarCPUR, RHIT, or similar
Work EnvironmentHealthcare insurance companies, hospitalsHealthcare insurance companies, hospitals
Job FocusReviewing and authorizing healthcare servicesCoordinating and managing review processes

Both roles involve reviewing healthcare services, often requiring similar certifications. The Utilization Management Rep primarily assesses and authorizes services, while the Utilization Review Coordinator manages the review process and coordinates between providers and payers. They often work in similar environments within the healthcare insurance industry, with overlapping responsibilities but different focus areas.

What states have the most Utilization Management Rep jobs?

States with the most job openings for Utilization Management Rep jobs include:

Utilization Management Rep jobs near you

Utilization Management Rep

Allmed Staffing Inc

Pearland, TX • Remote

Full-time

Medical, Dental, Vision, Retirement

Re-posted 28 days ago

Job description

Job Title: Utilization Management Representative (UMR)

Work Location: 11511 Shadow Creek Parkway
Schedule: Monday – Friday | 8:00 AM – 5:00 PM | 24–40 hours per week
Interview Process: Virtual interview via camera
Dress Code: Business Casual
Pay Rate: 13/hr (Paid Weekly)
Allmed Benefits: Vision, Health, Dental Insurance & 401(k)

Position Overview

The Utilization Management Representative (UMR) plays a critical role in supporting Utilization Management operations by ensuring the timely and accurate processing of authorization requests and communicating authorization determinations to providers and members. This role directly supports regulatory compliance, operational efficiency, and quality patient care by facilitating appropriate utilization of healthcare services.

The UMR serves as a key point of contact between providers, members, and the clinical review team while supporting overall care management strategies through efficient workflow management and effective communication.

Team Environment

The selected candidate will join a collaborative Utilization Management team consisting of approximately 20 Utilization Management Representatives (UMRs) working alongside clinical reviewers, including Registered Nurses (RNs), LVNs, and Medical Directors.

The team operates in a fast-paced, production-driven environment where accuracy, efficiency, and teamwork are critical to success. Team culture emphasizes:

  • Collaboration and strong communication
  • Accountability for productivity and quality metrics
  • Continuous learning and process improvement
  • Supportive teamwork across clinical and operational departments
  • Commitment to regulatory compliance and quality member care

Team members regularly collaborate with internal departments including clinical review teams, provider relations, claims, and appeals teams.

Key Responsibilities

  • Answer inbound calls from providers, members, and healthcare facilities regarding authorization requests, status updates, and coverage questions
  • Create authorization cases by reviewing and processing clinical requests received through fax, electronic submissions, or phone communication
  • Accurately document authorization requests within utilization management systems and/or electronic medical record systems
  • Coordinate with clinical review staff, including RNs, LVNs, and Medical Directors, to appropriately route cases requiring medical necessity review
  • Communicate authorization determinations verbally to providers and members in compliance with regulatory guidelines and organizational requirements
  • Maintain accurate records and ensure documentation standards are consistently met
  • Support workflow efficiency while managing multiple priorities in a high-volume environment
  • Provide exceptional customer service while maintaining confidentiality and professionalism

Required Qualifications

  • 1–3 years of healthcare experience, preferably within:
    • Utilization Management
    • Insurance operations
    • Medical office environments
    • Managed care settings
  • Experience handling high-volume calls in a professional and efficient manner
  • Strong data entry and documentation skills with high attention to detail
  • Ability to effectively manage multiple tasks simultaneously in a fast-paced environment
  • Strong verbal and written communication skills when interacting with providers, members, and internal teams
  • Basic understanding of healthcare authorization processes and insurance workflows
  • Experience using EMR/EHR platforms, case management systems, or related healthcare systems
  • Strong organizational and time-management skills

Preferred Qualifications

  • Experience supporting authorization processes within healthcare operations or managed care settings
  • Previous experience in health plans, hospitals, medical offices, or healthcare call center environments
  • Experience working with provider communication and care coordination activities
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