Remote Utilization Management Specialist II

Elevance Health; Miami (FL); Ibrido; USD 42.000 - 64.000; Tempo pieno

Descrizione del lavoro

Elevance Health is seeking an Utilization Management Representative II in Florida. The role involves handling incoming calls, triaging cases, authorizing inpatient and outpatient services, and gathering demographic information.

The position supports a hybrid/virtual work model with required in-person training sessions. The role requires a high school diploma or equivalent and at least two years of healthcare customer service experience, with strong communication and analytical skills.

Competenze

• Minimum of 2 years of customer service experience in a healthcare-related setting.
• Medical terminology training or coursework.
• Strong oral and written communication skills.
• Ability to handle multiple tasks and prioritize in a fast-paced environment.

Mansioni

• Manage incoming calls and triage and open cases.
• Authorize inpatient admission, outpatient precertification, prior authorization, and post-service requests.
• Obtain intake information from callers and verify benefits/eligibility.
• Conduct radius searches in Provider Finder and coordinate referrals.
• Refer cases for clinical review to a nurse reviewer as needed.
• Screen requests for precertification and/or prior authorization with scripts.
• Serve as liaison between Medical Management and internal departments.
• Respond to inquiries from clients and providers in a timely manner.
• Perform clinical screening as part of the intake process.

Conoscenze

Customer service

Healthcare terminology

Communication skills

Problem solving

Formazione

HS diploma or equivalent

Master’s degree (preferred in some contracts)

Strumenti

Medical terminology training

Descrizione del lavoro

Elevance Health is seeking an Utilization Management Representative II in Florida. The role involves handling incoming calls, triaging cases, authorizing inpatient and outpatient services, and gathering demographic information.

The position supports a hybrid/virtual work model with required in-person training sessions. The role requires a high school diploma or equivalent and at least two years of healthcare customer service experience, with strong communication and analytical skills.