Utilization Management Representative Lead

1 month ago


Tallahassee, Florida, United States Elevance Health Full time
Job Summary

We are seeking a highly skilled Utilization Management Representative Lead to join our team at Elevance Health. As a key member of our team, you will be responsible for providing technical guidance to UM Reps, ensuring quality control, and driving productivity.

Key Responsibilities
  • Provide technical guidance to UM Reps on complex customer service and call center experience.
  • Conduct quality control services, including call monitoring and UMR level I, II, and III audits.
  • Monitor daily phone activities to exceed NMIS standards and improve customer service levels.
  • Assist in supervising the daily activities of a group of Behavioral Health Associates.
  • Provide direction and guidance to less experienced team members.
  • Assist manager with PTO scheduling and monitoring attendance.
  • Handle escalated and unresolved calls from less experienced team members.
  • Keep team members informed of any changes.
  • Assist management by identifying areas of improvement and recommending solutions.
Requirements
  • HS diploma or equivalent and a minimum of 5 years related experience.
  • Complex customer service or call center experience and medical terminology training.
  • Knowledge of health plans, including familiarity with prior authorization and precertification process.
  • Strong knowledge of managed benefit programs.
Preferred Skills
  • Master's degree.
  • Knowledge of contracts.
  • Professional competencies, including oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
About Elevance Health

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 operate in a Hybrid Workforce Strategy, requiring associates to work at an Elevance Health location at least once per week.

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.



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