Utilization Management Representative I

WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Elevance Health requires a completed online application for consideration of employment for any position. We will never ask you for a credit card, send you a check, or ask you for payment as part of consideration for employment. Utilization Management Representative I Job Family: Customer Care Type: Full time Date Posted:Mar 29, 2024 Anticipated End Date:Apr 12, 2024 Reference: JR110000 Location: VA, NORFOLK PA, SEVEN FIELDS VA, ARLINGTON MA, BOSTON IN, INDIANAPOLIS OH, CINCINNATI VA, RICHMOND NY, NEW YORK CT, ROCKY HILL CA, RANCHO CORDOVA MI, WIXOM TN, BRENTWOOD DC, WASHINGTON NV, LAS VEGAS MN, MENDOTA HEIGHTS TN, KNOXVILLE MO, COLUMBIA VA, ASHBURN OH, COLUMBUS NC, CARY WA, LAKEWOOD WI, MADISON WV, CHARLESTON NE, LINCOLN DE, WILMINGTON OH, SEVEN HILLS ID, MERIDIAN ID, MERIDIAN NC, WINSTON GA, ATLANTA DC, WASHINGTON IL, DEERFIELD FL, TAMPA FL, ALTAMONTE SPRINGS FL, TALLAHASSEE KS, TOPEKA VA, ROANOKE NY, Lake Success CO, COLORADO SPRINGS FL, JACKSONVILLE CA, WOODLAND HILLS WI, Waukesha NJ, MORRISTOWN TN, MEMPHIS OH, MASON NY, ALBANY CA, SACRAMENTO CA, WALNUT CREEK PA, HERMITAGE KY, LOUISVILLE NH, MANCHESTER WA, SEATTLE TX, GRAND PRAIRIE IL, CHICAGO MI, DEARBORN VA, CHESAPEAKE TN, NASHVILLE MN, GILBERT LA, METAIRIE NY, MIDDLETOWN PR, San Juan IL, SPRINGFIELD GA, MIDLAND TX, HOUSTON CA, LOS ANGELES CT, WALLINGFORD MO, ST LOUIS GA, SAVANNAH CA, COSTA MESA MD, HANOVER NJ, ISELIN CA, CERRITOS OH, MASON IL, CHICAGO CO, DENVER NV, LAS VEGAS CA, PALO ALTO ME, SOUTH PORTLAND NY, LATHAM OH, COLUMBUS HI, KAPOLEI GA, AUGUSTA IA, W DES MOINES MA, WOBURN MA, NEWTON 55 CHAPEL ST Description Utilization Management Representative I Location: Within 50 miles of an Elevance pulse point Shift: Monday - Friday, an 8 hour shift between 8 am - 6 pm EST. This is a hybrid role.

You may be required to work in the office at least once per week The Utilization Management Representative 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: Medical terminology training and experience in 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. * For candidates working in person or remotely in the below locations, the salary range for this specific position is $14.97 to $26.94 Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting.

This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans.

The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is 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, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.

Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. 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. Unless 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 an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. 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 elevancehealthjobssupport@elevancehealth.com for assistance. EEO is the Law Equal Opportunity Employer / Disability / Veteran Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees. EEO Policy Statement Know Your Rights Pay Transparency Privacy Notice for California Residents Elevance Health, Inc.

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