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Utilization Management Representative Ii 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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Utilization Management Representative Ii information

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$24.5K

$44.2K

$77K

How much do utilization management representative ii jobs pay per year?

As of Aug 25, 2026, the average yearly pay for utilization management representative ii in the United States is $44,219.00, according to ZipRecruiter salary data. Most workers in this role earn between $37,500.00 and $43,000.00 per year, depending on experience, location, and employer.

What does a Utilization Management Representative II do?

A Utilization Management Representative II is responsible for reviewing medical service requests and determining if they meet established criteria for coverage under a health insurance plan. They collaborate with healthcare providers, patients, and insurance companies to ensure services are medically necessary and efficiently managed. This role typically involves processing prior authorizations, verifying benefits, and communicating decisions regarding coverage. Utilization Management Representatives help ensure patients receive appropriate care while controlling costs for both the insurer and the patient.

How does a Utilization Management Representative II collaborate with healthcare providers and insurance teams to ensure timely authorizations?

As a Utilization Management Representative II, you will regularly communicate with healthcare providers to gather necessary clinical information and clarify treatment plans. You'll also coordinate closely with insurance teams to review coverage policies and ensure that authorization requests are processed efficiently. This role requires balancing the needs of patients, providers, and payers, often managing multiple cases simultaneously. Strong organizational skills and clear communication are essential to keep workflows smooth and timely, especially when dealing with urgent or complex cases.

What are the key skills and qualifications needed to thrive as a Utilization Management Representative II, and why are they important?

To thrive as a Utilization Management Representative II, you need strong knowledge of healthcare regulations, medical terminology, and insurance processes, usually supported by a healthcare-related degree or relevant experience. Familiarity with utilization management software, claims processing systems, and electronic medical records is typically required. Excellent communication, attention to detail, and problem-solving skills help you effectively coordinate care and interact with providers and members. These abilities ensure accurate benefit determinations, regulatory compliance, and efficient patient care management.

What is the difference between Utilization Management Representative Ii vs Utilization Management Representative I?

AspectUtilization Management Representative IiUtilization Management Representative I
CredentialsHigh school diploma or equivalent; certification preferredHigh school diploma or equivalent; certification optional
Work EnvironmentHealthcare insurance companies, hospitals, or clinicsHealthcare insurance companies, hospitals, or clinics
ResponsibilitiesReviewing medical necessity, supporting case evaluations, handling complex casesAssisting with case reviews, data entry, basic case assessments

The main difference between Utilization Management Representative Ii and I lies in experience and complexity of tasks. The Ii role typically involves more complex case reviews and may require additional certifications, whereas the I role focuses on foundational tasks and data entry. Both positions are common in healthcare insurance settings and share similar work environments.

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What job categories do people searching Utilization Management Representative Ii jobs look for?

The top searched job categories for Utilization Management Representative Ii jobs are:

Utilization Management Representative Ii jobs near you
Infographic showing various Utilization Management Representative Ii job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $44,219 per year, or $21.3 per hour.

Utilization Management Rep

Pearland, TX • Remote

Allmed Staffing Inc
Recruiting and Staffing Services • 11 - 50 employees
Learn more about Allmed Staffing Incexternal

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
    #ZR

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