Elevance Health
Utilization Management Representative I
Elevance Health, Atlanta, Georgia, United States, 30383
Anticipated End Date:
2024-11-15Position Title:
Utilization Management Representative IJob Description:The
Utilization Management Representative I
will be 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:HS diploma or GEDMinimum 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 the medical or insurance field 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.Salary:
For candidates working in person or remotely in the below locations, the salary range for this specific position is $15.72/hr. to $23.57/hr.Locations:
New YorkIn addition to your salary, Elevance Health
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2024-11-15Position Title:
Utilization Management Representative IJob Description:The
Utilization Management Representative I
will be 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:HS diploma or GEDMinimum 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 the medical or insurance field 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.Salary:
For candidates working in person or remotely in the below locations, the salary range for this specific position is $15.72/hr. to $23.57/hr.Locations:
New YorkIn addition to your salary, Elevance Health
#J-18808-Ljbffr