Remote Utilization Management Specialist II

Elevance Health, Inc.; Mason (OH); Remote; USD 42,000 - 64,000; Full time

Job summary

Elevance Health, Inc. is seeking an Utilization Management Representative II. The role is primarily virtual full-time with required in-person training sessions.

The position is based in Mason, OH with potential considerations for Durham, NC and Tampa, FL. Schedule is 8 hours per day, 8:00 am to 5:00 pm EST, Monday through Friday, with extra hours as needed. The incumbent will manage calls, determine eligibility, authorize inpatient/outpatient services, collect demographics, and coordinate

Qualifications

• HS diploma or equivalent with 2 years healthcare customer service.
• Medical terminology training or equivalent background.

Responsibilities

• 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.
• Obtains intake (demographic) information from caller.
• Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given.
• Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care.
• Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization.
• Verifies benefits and/or eligibility information.
• May act as liaison between Medical Management and internal departments.
• Responds to telephone and written inquiries from clients, providers and in-house departments.
• Conducts clinical screening process.

Skills

Customer service

Healthcare terminology

Education

HS diploma or equivalent

Tools

Excel

Job description

Elevance Health, Inc. is seeking an Utilization Management Representative II. The role is primarily virtual full-time with required in-person training sessions.

The position is based in Mason, OH with potential considerations for Durham, NC and Tampa, FL. Schedule is 8 hours per day, 8:00 am to 5:00 pm EST, Monday through Friday, with extra hours as needed. The incumbent will manage calls, determine eligibility, authorize inpatient/outpatient services, collect demographics, and coordinate