Remote Utilization Management Lead – Coaching & QA

Elevance Health; Columbus (GA); On-site; USD 70,000 - 98,000; Full time

Job summary

Elevance Health seeks a seasoned Utilization Management Representative Lead in Columbus, GA, with virtual/hybrid work options. The role guides UM Reps, monitors performance, and ensures high-quality service for precertification and post-service requests.

Strong communication and analytical skills are essential in this leadership position. The position involves supervising a team, coordinating scheduling, addressing escalations, and driving process improvements in a compliant, member-focused

Qualifications

• HS diploma or equivalent.
• Minimum of 5 years related experience including complex customer service or call center experience and medical terminology training.

Responsibilities

• Motivates and encourages 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 efficiency.
• Monitors daily phone activities to exceed NMIS standards and improve customer service levels.
• Assists in supervising daily activities of Behavioral Health Associates.
• Provides direction and guidance to less experienced team members.
• Assists management with PTO scheduling and attendance monitoring.
• Handles escalated and unresolved calls and complex situations.
• Keeps department manuals up-to-date and informs team of changes.
• Researches resources for reports and analyzes productivity and time off.

Skills

leadership guidance

communication

interpersonal skills

analytical skills

problem-solving

Education

HS diploma or equivalent

Job description

Elevance Health seeks a seasoned Utilization Management Representative Lead in Columbus, GA, with virtual/hybrid work options. The role guides UM Reps, monitors performance, and ensures high-quality service for precertification and post-service requests.

Strong communication and analytical skills are essential in this leadership position. The position involves supervising a team, coordinating scheduling, addressing escalations, and driving process improvements in a compliant, member-focused