Elevance Health
Utilization Management Representative II - Part Time
Elevance Health, Atlanta, Georgia, United States, 30383
Utilization Management Representative II
Location:
Seeking candidates that reside within 50 miles of the
Atlanta, GA
or
Columbus, GA
PulsePoint office location. May be asked to go onsite for trainings, meetings or as needed. Work Schedule:
Part-time, 20 hours/week The
Utilization Management Representative II
is responsible for managing incoming calls, including triage, opening of cases and authorizing sessions. How you will make an impact: Managing incoming calls or incoming post services claims work. Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests. Obtains intake (demographic) information from caller. Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given. Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization. Verifies benefits and/or eligibility information. May act as liaison between Medical Management and internal departments. Responds to telephone and written inquiries from clients, providers and in-house departments. Conducts clinical screening process. Minimum Requirements: Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities & Experiences: Experience and knowledge of PASRR process. Clerical/Administrative experience preferred. Experience working in the healthcare industry 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.
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Seeking candidates that reside within 50 miles of the
Atlanta, GA
or
Columbus, GA
PulsePoint office location. May be asked to go onsite for trainings, meetings or as needed. Work Schedule:
Part-time, 20 hours/week The
Utilization Management Representative II
is responsible for managing incoming calls, including triage, opening of cases and authorizing sessions. How you will make an impact: Managing incoming calls or incoming post services claims work. Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests. Obtains intake (demographic) information from caller. Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given. Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization. Verifies benefits and/or eligibility information. May act as liaison between Medical Management and internal departments. Responds to telephone and written inquiries from clients, providers and in-house departments. Conducts clinical screening process. Minimum Requirements: Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities & Experiences: Experience and knowledge of PASRR process. Clerical/Administrative experience preferred. Experience working in the healthcare industry 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.
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