Utilization Management Representative
3 weeks ago
We are seeking a highly skilled Utilization Management Representative to join our team at Elevance Health. As a Utilization Management Representative, you will play a critical role in ensuring that our members receive the necessary healthcare services while minimizing unnecessary costs.
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
- Responsible for the identification and data entry of referral requests into the UM system
- Responds to telephone and written inquiries from clients, providers, and in-house departments
- Conducts clinical screening process
- Authorizes initial set of sessions to provider
- Checks benefits for facility-based treatment
- Develops and maintains positive customer relations and coordinates with various functions within the company
- Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience
- Medical terminology training and experience in medical or insurance field preferred
- Behavioral health experience
- Microsoft Office experience
We offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution. The salary range for this position is $15.72 to $25.82/hr.
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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