Elevance Health
Utilization Management Representative I
Elevance Health, Walnut Creek, California, United States, 94598
Overview
1 week ago Be among the first 25 applicants Get AI-powered advice on this job and more exclusive features. This range is provided by Elevance Health. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range
$16.31/hr - $27.97/hr Location: California, Nevada (hybrid/virtual work with in-person training sessions as required) Hours: Working hours will be 8:35 AM to 5:05 PM Pacific. Training hours may vary. Position Title: Utilization Management Representative I Job Description: Utilization Management Representative I Responsibilities
Managing incoming calls or posted services claims work. 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. Identifies and enters 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. Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner. Multitasks across calls, texts, facsimiles, and electronic queues while taking notes and speaking with customers. Demonstrates focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills; attention to detail; critical thinking and problem-solving; empathy and persistence to resolve caller issues. Structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary. Performs other duties as assigned. Minimum Requirements
Requires HS diploma or GED and a 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, Capabilities And Experiences
Medical terminology training and experience in medical or insurance field preferred. For URAC accredited areas, strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. High-volume inbound call center experience; strong time management skills and ability to function in a high-volume environment is strongly preferred. Location and Salary Notes
For candidates working in person or virtually in the listed location(s), the salary range for this position is $16.31 to $27.97. Locations: California, Nevada Company Information
Elevance Health is an Equal Employment Opportunity employer. See below for additional policy statements and benefits information as part of the posting. We are 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.
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1 week ago Be among the first 25 applicants Get AI-powered advice on this job and more exclusive features. This range is provided by Elevance Health. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range
$16.31/hr - $27.97/hr Location: California, Nevada (hybrid/virtual work with in-person training sessions as required) Hours: Working hours will be 8:35 AM to 5:05 PM Pacific. Training hours may vary. Position Title: Utilization Management Representative I Job Description: Utilization Management Representative I Responsibilities
Managing incoming calls or posted services claims work. 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. Identifies and enters 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. Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner. Multitasks across calls, texts, facsimiles, and electronic queues while taking notes and speaking with customers. Demonstrates focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills; attention to detail; critical thinking and problem-solving; empathy and persistence to resolve caller issues. Structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary. Performs other duties as assigned. Minimum Requirements
Requires HS diploma or GED and a 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, Capabilities And Experiences
Medical terminology training and experience in medical or insurance field preferred. For URAC accredited areas, strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. High-volume inbound call center experience; strong time management skills and ability to function in a high-volume environment is strongly preferred. Location and Salary Notes
For candidates working in person or virtually in the listed location(s), the salary range for this position is $16.31 to $27.97. Locations: California, Nevada Company Information
Elevance Health is an Equal Employment Opportunity employer. See below for additional policy statements and benefits information as part of the posting. We are 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.
#J-18808-Ljbffr