Remote Utilization Management Rep I Authorization

Elevance Health; Seven Fields (Butler County); Remoto; USD 25.000 - 33.000; Tempo pieno

Descrizione del lavoro

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews, handling calls and administrative tasks with accuracy and efficiency.

The role emphasizes strong communication, empathy, and the ability to multi-task in a fast-paced setting within a hybrid/remote work structure and required in-person onboarding sessions.

Competenze

• HS diploma or GED.
• Minimum of 1 year of customer service or call-center experience; or equivalent background.

Mansioni

• Coordinating cases for precertification and prior authorization review.
• Managing incoming calls and post service 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.
• Enters referral requests into the UM system per plan certificate.
• Responds to inquiries from clients, providers and internal departments.
• Conducts clinical screening for cases.
• Authorizes initial set of sessions to provider.
• Checks benefits for facility-based treatment.
• Maintains positive customer relations and coordinates with functions within the company.
• Multitasks across calls, texts, faxes, and electronic queues while taking notes.
• Maintains focus in a fast-paced, high-pressure environment.

Conoscenze

Customer service

Medical terminology

Formazione

High school diploma or GED

Descrizione del lavoro

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews, handling calls and administrative tasks with accuracy and efficiency.

The role emphasizes strong communication, empathy, and the ability to multi-task in a fast-paced setting within a hybrid/remote work structure and required in-person onboarding sessions.