Utilization Management Representative - DME - Remote

Since its inception in 1996, J&B Medical has become a recognized market leader in healthcare. More than a family-owned business, we are a family of businesses that span across all aspects of medical-related care including: insurance covered products, sole source program management and national managed care contracts, medical-surgical products, emergency-medical products, retail home-care products, veterinary products, and technology solutions. J&B Medical is a national certified Women’s Business Enterprise composed of knowledgeable industry professionals. J&B’s passionate teams are motivated to provide exceptional service at every interaction. Our goal is simple: enhance the quality of life, improve clinical outcomes, and reduce healthcare costs. J&B Medical settles for nothing less than the most innovative industry practices and the highest level of integrity.

The Utilization Management Representative is responsible for coordinating cases for prior authorization reviews, ensuring compliance with organizational and regulatory requirements. Need to communicate clearly and professionally with members, providers, and internal departments. This full-time position requires excellent customer service skills, strong attention to detail, and the ability to analyze situations effectively to ensure timely and accurate case processing. The role involves verifying insurance for DME supplies, submitting prior authorizations, requesting documentation, following up on documentation requests, processing orders for shipment and maintaining positive customer relations while adhering to company policies and procedures. HIRING REMOTE EXPERIENCED CSR'S IN THE FOLLOWING STATES: AL FL, GA, IN, KY, LA, MS, NC, SC, TN, TX, VA, & WV

Incoming/Outgoing calls Review contract and benefit eligibility. Refer cases requiring clinical review to internal review and/or submit to insurance provider for prior authorization Data entry Respond to telephone and written inquiries from members, providers, Manufacturers, and in-house departments., Conduct clinical screening processes., Request clinical documents from Providers, Follow up on requested documentation Develop and maintain positive customer relations and coordinate with various functions within the company., Participate in developing department goals, objectives, and systems., Attend staff meetings and other meetings and seminars as assigned., Recommend new approaches, policies, and procedures to improve department efficiency., Perform other related duties as assigned.