Utilization Management Coordinator
5 days ago
Location:
This role will work in a hybrid model, with a mix of remote and office work. Ideal candidates will live within 50 miles of one of our PulsePoint locations.
Job Summary:
The Utilization Management Representative I will be responsible for coordinating cases for precertification and prior authorization review. This role will involve managing incoming calls and post-service claims work, determining contract and benefit eligibility, and providing authorization for inpatient admission, outpatient precertification, prior authorization, and post-service requests.
Key Responsibilities:
- Manage incoming calls and post-service claims work
- Determine contract and benefit eligibility
- Provide authorization for inpatient admission, outpatient precertification, prior authorization, and post-service requests
- Refer cases requiring clinical review to a Nurse reviewer
- Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate
- 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
- Develop and maintain positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner
Requirements:
- HS 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:
- Medical terminology training and experience in medical or insurance field preferred
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.
Hybrid Workforce Strategy:
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times 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.
Equal Employment Opportunity:
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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