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Clinical Case Coordinator

4 weeks ago

Cincinnati, Ohio, United States Elevance Health Full time

Job Summary:

The Utilization Management Representative I will be responsible for coordinating cases for precertification and prior authorization review. This role requires strong communication and organizational skills to manage incoming calls and post-service claims work.

Key Responsibilities:

  • Determines contract and benefit eligibility; provides 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 in accordance with the plan certificate.
  • 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.

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:

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.

Accommodation:

Applicants who require accommodation to participate in the job application process may contact for assistance.