• Utilization Management Clerk

    Job Locations US-CA-Aliso Viejo
    Req No.
    Regular Full-Time
  • Overview

    The Utilization Management (UM) Program for Concerto Healthcare is designed to promote the delivery of high quality, medically necessary, and cost efficient health care for our members.  The program is under the administrative and clinical direction of the Chief Medical Officer. This position is responsible for a variety of support such as approval letter generation, mailing, returned mail, queue management, incoming faxes within the utilization management department.


    • Be a resource to providers and Concerto staff regarding specific approval letters and/or approval process
    • Provide requested information during appeals process 
    • Assist other departments in creating approval documentation as requested 
    • Makes and receives phone calls to exchange information to accomplish tasks
    • Organizes/maintainers records, lists, and handles mail.
    • Types letters, forms and other documents, checks documents for accuracy and completeness, and cross-references information.
    • Provides timely and accurate resolution of  issues.
    • Review file for completeness of required documentation, including but not limited to: confirmation of receipt of notification, copies of written notification, correspondence with members and providers


    Requires a high school diploma or GED.


    • 3 -5 years of professional  experience; or any combination of education and experience, which would provide an equivalent background.
    • Ability to operate basic office equipment such as personal computers and basic software packages, fax machines, copiers, and telephone systems.
    • Able to organize and prioritize workload; work well under pressure; problem solve; pay close attention to detail; work independently with minimal supervision.  
    •  Knowledge of medical terminology preferred.


    Computer Skills:

    • Basic computer skills in a Windows operating environment including Microsoft Word, Excel, and an e-mail system. 

    Knowledge / Skills / Abilities:

    • High energy; demonstrates an ability to function in a creative, entrepreneurial environment and think outside the box.
    • Self-starter, proactive, who works quickly and accurately and will prioritize and meet deadlines effectively. 
    • Ability to work effectively and establish and promote positive relationships. 
    • Strong interpersonal and decision-making skills; must be able to introduce new ideas, processes, and tools to improve department performance.
    • Superior organization and multi-tasking skills; detail-oriented. 



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