Utilization Management Associate I — Remote

Elevance Health (Anthem); Meridian (ID); Híbrido; USD 40 000 - 56 000; Tempo integral

Resumo da oferta

Elevance Health is seeking an Utilization Management Representative I to support calls, eligibility determinations, and prior authorization processes from a flexible work setup. Meridian, Idaho preferred with virtual work options and occasional in-person training requirements.

The role involves clinical review referrals, UM system data entry, and cross-functional collaboration to ensure accurate, timely benefit determinations and patient care coordination.

Qualificações

• Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience.
• Medical terminology training.
• Experience in a medical or insurance field.
• For URAC accredited areas, strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Responsabilidades

• Manage incoming calls or incoming post services claims work.
• Determine contract and benefit eligibility.
• Provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
• Refer cases requiring clinical review to a Nurse reviewer.
• Identify and enter referral requests into the UM system in accordance with the plan certificate.
• Respond to telephone and written inquiries from clients, providers and in-house departments.
• Conduct clinical screening process.
• Authorize initial set of sessions to provider.
• Check benefits for facility based treatment.
• Develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

Conhecimentos

Customer service

Call center

Medical terminology

Formação académica

High school diploma

Descrição da oferta de emprego

Elevance Health is seeking an Utilization Management Representative I to support calls, eligibility determinations, and prior authorization processes from a flexible work setup. Meridian, Idaho preferred with virtual work options and occasional in-person training requirements.

The role involves clinical review referrals, UM system data entry, and cross-functional collaboration to ensure accurate, timely benefit determinations and patient care coordination.