Elevance Health
Utilization Management Representative II (California)
Elevance Health, Costa Mesa, California, United States, 92626
Overview
Join to apply for the
Utilization Management Representative II (California)
role at
Elevance Health . Base pay range:
$19.16/hr - $31.10/hr . Anticipated End Date: 2025-10-24. Position Title: Utilization Management Representative II (California). Job Description: Utilization Management Representative II. This role enables associates to work virtually full-time, with in-person training sessions as required. This approach promotes productivity and work-life integration with essential onboarding and skill development. The policy on hybrid/virtual work states that candidates not within a reasonable commuting distance will not be considered unless an accommodation is required by law. Location: California. Work arrangement may be hybrid/virtual per posting. What You Will Do / 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. Obtain intake (demographic) information from caller. Conduct radius search in Provider Finder and follow up with providers on referrals. Refer cases requiring clinical review to a nurse reviewer; handle referrals for specialty care. Process incoming requests and collect information needed for review from providers, using scripts to screen basic and complex requests for precertification and/or prior authorization. Verify benefits and/or eligibility information. Act as liaison between Medical Management and internal departments as needed. Respond to telephone and written inquiries from clients, providers and in-house departments. Conduct clinical screening process. Minimum Requirements
HS diploma or equivalent Minimum of 2 years customer service experience in a healthcare-related setting and medical terminology training; or any combination of education and experience providing equivalent background. Additional Details
Locations: California Employment type: Contract Seniority level: Entry level Job function: Health Care Provider Industries: Hospitals and Health Care Elevance Health offers a comprehensive benefits package and other programs. The salary range is based on legitimate, non-discriminatory factors and may vary by location, experience, and other considerations. The company is committed to equal pay opportunities and equal employment opportunity.
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Join to apply for the
Utilization Management Representative II (California)
role at
Elevance Health . Base pay range:
$19.16/hr - $31.10/hr . Anticipated End Date: 2025-10-24. Position Title: Utilization Management Representative II (California). Job Description: Utilization Management Representative II. This role enables associates to work virtually full-time, with in-person training sessions as required. This approach promotes productivity and work-life integration with essential onboarding and skill development. The policy on hybrid/virtual work states that candidates not within a reasonable commuting distance will not be considered unless an accommodation is required by law. Location: California. Work arrangement may be hybrid/virtual per posting. What You Will Do / 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. Obtain intake (demographic) information from caller. Conduct radius search in Provider Finder and follow up with providers on referrals. Refer cases requiring clinical review to a nurse reviewer; handle referrals for specialty care. Process incoming requests and collect information needed for review from providers, using scripts to screen basic and complex requests for precertification and/or prior authorization. Verify benefits and/or eligibility information. Act as liaison between Medical Management and internal departments as needed. Respond to telephone and written inquiries from clients, providers and in-house departments. Conduct clinical screening process. Minimum Requirements
HS diploma or equivalent Minimum of 2 years customer service experience in a healthcare-related setting and medical terminology training; or any combination of education and experience providing equivalent background. Additional Details
Locations: California Employment type: Contract Seniority level: Entry level Job function: Health Care Provider Industries: Hospitals and Health Care Elevance Health offers a comprehensive benefits package and other programs. The salary range is based on legitimate, non-discriminatory factors and may vary by location, experience, and other considerations. The company is committed to equal pay opportunities and equal employment opportunity.
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