Remote Utilization Management Lead - Coaching & Audits

Anthem Blue Cross & Blue Shield; Columbus (GA); Hybrid; USD 65,000 - 95,000; Full time

Job summary

Elevance Health is seeking a Utilization Management Representative Lead in Columbus, GA. The role supports virtual work with mandatory in-person training and requires commuting distance alignment.

The Lead provides technical guidance, audits and supervision for a team handling precertification, prior authorization and post-service requests. With 5+ years in complex customer service or call centers and medical terminology training, you will influence processes, monitor performance against

Qualifications

• Minimum of 5 years related experience including complex customer service or call center experience and medical terminology training.
• Knowledge of health plans, prior authorization and precertification processes.
• Knowledge of contracts and managed benefit programs.
• URAC competencies require strong oral, written and interpersonal communication skills, problem-solving, facilitation and analytical skills.

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 and keep staff informed of changes.
• Supervises the daily activities of Behavioral Health Associates and guides less experienced team members.
• Assists manager with PTO scheduling and attendance; handles escalated calls.
• Directs UM Reps to appropriate resources for complex issues and resolutions.
• Keeps departmental manuals up-to-date and researches resources for reports.
• Obtains and analyzes statistical information related to units of work, productivity, and time off.

Skills

Customer service

Call center experience

Medical terminology

Analytical skills

Interpersonal skills

Oral communication

Problem solving

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 mandatory in-person training and requires commuting distance alignment.

The Lead provides technical guidance, audits and supervision for a team handling precertification, prior authorization and post-service requests. With 5+ years in complex customer service or call centers and medical terminology training, you will influence processes, monitor performance against