Utilization Management Representative I

Anticipated End Date: 2026-11-11 Position Title: Utilization Management Representative I Job Description: Utilization Management Representative I Location: Any PulsePoint location. Residing in Meridian, Idaho is preferred. Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. The Utilization Management Representative I will be responsible for coordinating cases for precertification and prior authorization review. How you will make an impact: - Manage incoming calls or incoming post services claims work. - Determine contract and benefit eligibility. - Provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests. - Refer cases requiring clinical review to a Nurse reviewer. - Identify and enter referral requests into the UM system in accordance with the plan certificate. - Respond to telephone and written inquiries from clients, providers and in-house departments. -