Kristine

Utilization Management Associate/Prior Authorization Associa

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Overview

Looking for full-time work (8 hours/day)

at $4.25/hour ($818.18/month)

Bachelors degree

Last Active

July 11th, 2026 (yesterday)

Member Since

March 25th, 2024

Profile Description

I've worked in a health insurance company for almost 3 years as a Utilization Management Associate where I receive and process precertification request through e-fax, portals, emails sent from hospitals, doctor's offices, facilities, clinics, laboratories, vendors, etc. for medical service request such as inpatient admission, outpatient procedures, referrals, home health care, laboratories, DME's, etc. My primary task is to review and assess the request, ensuring adherence to HIPAA regulations and prior authorization requirements. Create a case for request that requires prior authorization for nurses to review for medical necessity. Part of my job is also to determine provider's network status and verify patient insurance coverage including benefits, eligibility, and limitations.