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Utilization Management Representative II

2 months ago

Woodland Hills, United States Elevance Health Full time

Utilization Management Representative II

Location : This is a remote position. Candidates must live in the state of California . Seeking candidates that reside within 50 miles of the following Elevance Health PulsePoint office locations : Costa Mesa, Cerritos, Woodland Hills, Los Angeles, Palo Alto, Walnut Creek, Rancho Cordova and Sacramento, CA.

The Utilization Management Representative II is responsible for managing incoming calls, including triage, opening of cases and authorizing sessions.

How you will make an impact :

  • Managing incoming calls and carrying a caseload of outbound calls.

  • Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.

  • Helps connect members to community resources and services.

  • Obtains intake (demographic) information from caller.

  • Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given.

  • Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization.

  • Verifies benefits and/or eligibility information.

  • May act as liaison between Medical Management, internal departments and community resources.

  • Responds to telephone and written inquiries from clients, providers and in-house departments.

Minimum Requirements:

  • Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities & Experiences:

  • Behavioral health experience - mental health and substance use disorders preferred.

  • Knowledge of community resources and social determinants of health.

  • Case management experience.

  • 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 location(s), the salary* range for this specific position is $18.33 to $29.99/hr.

Location: California

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.