Remote Utilization Management Lead

The Elevance Health Companies, Inc.; Columbus (GA); On-site; USD 85,000 - 110,000; Full time

Job summary

Elevance Health is seeking a Utilization Management Representative Lead in Columbus, GA. The role supports virtual work with required in-person training and occasional alternate locations within commuting distance.

The incumbent will motivate the UM Reps, conduct audits, and drive productivity while ensuring alignment with NMIS and MTM standards. Minimum 5 years in complex customer service or call center with medical terminology training; knowledge of health plans and prior authorization is

Qualifications

• HS diploma or equivalent.
• Minimum of 5 years related experience to include complex customer service or call center experience and medical terminology training; or any combination of education and experience which would provide an equivalent background.

Responsibilities

• Motivates and guides UM Reps while providing technical guidance.
• Provides quality control services such as call monitoring and audits for NMIS and MTM standards.
• Suggests methods to improve productivity.
• Understands workflows, priorities and guidelines.
• Monitors daily phone activities to exceed NMIS standards.
• Supervises and guides Behavioral Health Associates.
• Assists in PTO scheduling and attendance monitoring.
• Handles escalated calls and directs to appropriate resources.
• Identifies improvements and informs management.
• Keeps manuals up-to-date and researches resources for reports.

Skills

Customer service

Call center

Medical terminology

Communication

Analytical skills

Problem-solving

Prior authorization

Precertification

Education

HS diploma or equivalent

Job description

Elevance Health is seeking a Utilization Management Representative Lead in Columbus, GA. The role supports virtual work with required in-person training and occasional alternate locations within commuting distance.

The incumbent will motivate the UM Reps, conduct audits, and drive productivity while ensuring alignment with NMIS and MTM standards. Minimum 5 years in complex customer service or call center with medical terminology training; knowledge of health plans and prior authorization is