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Clinical Operations Specialist
2 months ago
We are seeking a skilled Healthcare Utilization Coordinator to join our team at Elevance Health. As a key member of our operations team, you will play a critical role in ensuring the smooth coordination of healthcare services for our members.
Key Responsibilities- Case Management: Coordinate cases for precertification and prior authorization review, ensuring that all necessary documentation is complete and accurate.
- Client Communication: Respond to telephone and written inquiries from clients, providers, and in-house departments, providing timely and effective communication.
- Clinical Screening: Conduct clinical screening processes to determine contract and benefit eligibility, and provide authorization for inpatient admission, outpatient precertification, prior authorization, and post-service requests.
- Referral Management: Identify and data-enter referral requests into the UM system in accordance with the plan certificate, ensuring accurate and timely processing.
- Collaboration: Develop and maintain positive customer relations, coordinating with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
- Education: High School diploma or GED required; minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
- Skills: Medical terminology training and experience in medical or insurance field preferred; experience working with computer applications/digital skills strongly preferred.
As a valued member of our team, you will enjoy a comprehensive benefits package, including medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources. Elevance Health operates in a Hybrid Workforce Strategy, with associates required to work at an Elevance Health location at least once per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
