Job Summary

Utilization Management Representative

  • Location:
    Newbury Park, California
  • Job reference:
  • Category:
    Help Desk/Technical Support
  • Contract Type:

Modis has an immediate opening for a Utilization Management Representative in Newbury Park, CA. We are seeking individuals with a passion for helping others and excellent communication skills. This company has a progressive environment that will allow you to sharpen your skills with new technology. You will be responsible for giving clear and professional call resolution related to Healthcare-related eligibility/benefits. If you or anyone you know is looking for a new opportunity, take a moment to review this job description!
4-month contract w/potential of extension
Schedule: 8am - 5pm
Primary duties may include, but are not limited to:

  • Managing incoming calls or incoming post services claims work.
  • Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient pre-certification, prior authorization, and post service requests.
  • Refers cases requiring clinical review to a Nurse reviewer.
  • Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
  • Responds to telephone and written inquiries from clients, providers and in-house departments.
  • Conducts clinical screening process.
  • Authorizes initial set of sessions to provider.
  • Checks benefits for facility based treatment.
  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.


  • HS diploma or the equivalent; 1+ year(s) experience in customer service or call center
  • Computer/Data Entry proficiency
  • Medical terminology and experience in medical or insurance field preferred
  • Proficient analytical, written and oral communication skills

If you are experienced in customer service, knowledgeable in healthcare/insurance and are exploring new opportunities in Newbury Park, CA - Apply Today!

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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

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