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Utilization Management Coordinator

2 months ago

Louisville, Kentucky, United States Elevance Health Full time
About the Role

We are seeking a highly skilled Utilization Management Representative I 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 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.
  • Responsible for the identification and data entry of 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, ensuring accurate and efficient decision-making.
  • Authorize initial sets of sessions to providers, promoting timely access to care.
  • Check benefits for facility-based treatment, ensuring compliance with plan guidelines.
  • Develop and maintain positive customer relationships, coordinating with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
Requirements
  • High School diploma or GED
  • Minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background
  • Preferred Skills, Capabilities, and Experiences:
    • Medical terminology training and experience in the medical or insurance field
    • FHPS experience
    • Strong oral, written, and interpersonal communication skills
    • Problem-solving skills
    • Facilitation skills
    • Analytical skills
About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. 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.

Our Culture

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes, and drive our shared success – for our consumers, our associates, our communities, and our business.

Benefits

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources, to name a few.