• Job Description

  Req#: JR89160

  Position Title:

  Utilization Management Rep I

  Job Description:

  Utilization Management Rep I

  Locations: GA-Atlanta, GA-Midland, IN-Indianapolis, KY-Louisville, OH-Cincinnati, ME-South Portland, MO-St Louis, VA-Norfolk, VA-Richmond and VA-Roanoke.

  Elevance Health supports a hybrid workplace model with pulse point sites (major office) used for collaboration, community, and connection. This position can be primarily remote, however will be based within 50 miles of a pulse point site listed above.

  Work Hours: Monday – Friday, 10:30AM to 7:00PM EST.

  The Utilization Management Rep I is responsible for coordinating cases for precertification and prior authorization review.

  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.
  • 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.
  • 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.

  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:

  • Previous FEP/FHPS experience is strongly preferred.
  • Medical terminology training and experience in medical or insurance field preferred.

  Job Level:

  Non-Management Non-Exempt

  Workshift:

  1st Shift (United States of America)

  Job Family:

  CUS > Care Support

  Be part of an Extraordinary Team

  Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

  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.

  Elevance Health operates in a Hybrid Workforce Strategy, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and 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.

  The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

  Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

• About the company

  Elevance Health, Inc. is an American health insurance provider.

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