Utilization Management Representative
2 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 coordinating cases for precertification and prior authorization review.
Key Responsibilities- Manage incoming calls and post-service claims work, ensuring timely and accurate processing.
- Determine contract and benefit eligibility, providing authorization for inpatient admission, outpatient precertification, prior authorization, and post-service requests.
- Refer cases requiring clinical review to a Nurse reviewer, ensuring seamless coordination of care.
- Identify and data-enter referral requests into the UM system, adhering to plan certificate guidelines.
- Respond to telephone and written inquiries from clients, providers, and in-house departments, providing exceptional customer service.
- Conduct clinical screening processes, authorizing initial sessions with providers, and checking benefits for facility-based treatment.
- Develop and maintain positive customer relationships, coordinating with various functions within the company to ensure timely and effective resolution of customer requests.
- High School diploma or GED, with a minimum of 1 year of customer service or call-center experience.
- Medical terminology training and experience in the medical or insurance field are preferred.
At Elevance Health, we offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs. We also provide medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.
We operate in a Hybrid Workforce Strategy, requiring associates 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws.
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Utilization Management Representative
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