Utilization Management Representative
3 weeks ago
We are seeking a highly skilled Utilization Management Representative to join our team at Elevance Health. As a key member of our healthcare team, you will play a critical role in ensuring that our members receive the best possible care while also managing costs and improving outcomes.
Key Responsibilities- Coordinate cases for precertification and prior authorization review
- Determine contract and benefit eligibility
- Provide authorization for inpatient admission, outpatient precertification, prior authorization, and post-service requests
- Refers cases requiring clinical review to a Nurse reviewer
- Identify and data enter referral requests into the UM system
- Respond to telephone and written inquiries from clients, providers, and in-house departments
- Conduct clinical screening process
- Authorize initial set of sessions to provider
- Check benefits for facility-based treatment
- High School diploma or GED
- Minimum 1 year of customer service or call-center experience
- Medical terminology training and experience in medical or insurance field preferred
- Strong oral, written, and interpersonal communication skills
- Problem-solving skills
- Facilitation skills
- Analytical skills
Elevance Health is a health company dedicated to improving lives and communities. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
We offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs. We also offer 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, requiring associates to work at an Elevance Health location at least once per week. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
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