Utilization Management Representative III

2 weeks ago

Palo Alto, United States Elevance Health Full time

Utilization Management Representative III

Location: Remote - the ideal candidate lives within 50 miles of a Pulse Point location.

The Utilization Management Representative III is responsible for coordinating cases for precertification and prior authorization review.

How you will make an impact:

  • Responsible for providing technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services outside of initial authorized set.

  • Assisting management by identifying areas of improvement and expressing a willingness to take on new projects as assigned.

  • Handling escalated and unresolved calls from less experienced team members. Ensuring UM Reps are directed to the appropriate resources to resolve issues. Ability to understand and explain specific workflow, processes, departmental priorities and guidelines.

  • May assist in new hire training to act as eventual proxy for Ops Expert. Exemplifies behaviors embodied in the 5 Core Values.

Minimum Requirements:

  • Requires a HS diploma or GED and a minimum of 3 years of experience in customer service experience in healthcare related setting; or any combination of education and experience which would provide an equivalent background.

  • Medical terminology training required.

Preferred Skills, Capabilities and Experiences:

  • Certain contracts require a Master's degree.

  • For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $20.54 to $36.97

Locations: California; Colorado; Nevada; New York; Washington State

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

  • The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

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