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Utilization Management Coordinator

2 months ago

Richmond, Virginia, United States Elevance Health Full time
Job Title: Utilization Management Representative I

Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.

Job Summary:

We are seeking a highly skilled Utilization Management Representative I to join our team. As a key member of our team, you will be responsible for coordinating cases for precertification and prior authorization review.

Key Responsibilities:

  • Manage incoming calls or incoming post services 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 coordinate 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.
  • For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Compensation and Benefits:

The salary range for this position is $15.72/hr. to $23.57/hr. Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution.

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.

Work Environment:

Elevance Health operates in a Hybrid Workforce Strategy. 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.

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.