Utilization Management Rep I

Elevance Health; Tampa (FL); Hybrid; USD 25,000 - 34,000; Part time

Job summary

Elevation Health? Elevance Health is seeking candidates for a contract role focused on precertification coordination and claims work. The position requires organizing cases, determining eligibility, and providing timely authorizations.

You will interact with clients, providers, and internal teams in a home-based setting within a hybrid work model. Applicants should have a HS diploma or GED with at least 1 year in customer service, plus knowledge of medical terminology.

Qualifications

• HS diploma or GED with 1 year of customer service or call-center experience
• Medical terminology training and experience in medical or insurance field preferred
• Strong oral, written and interpersonal communication skills, problem-solving, facilitation, and analytical skills

Responsibilities

• Coordinate cases for precertification and prior authorization review
• Manage incoming calls and post services claims work
• Determine contract and benefit eligibility; authorize inpatient admission, outpatient precertification, prior authorization, and post service requests
• Refer cases requiring clinical review to a Nurse reviewer
• Identify and data-entry referral requests into the UM system per plan certificate
• Respond to inquiries from clients, providers and in-house departments
• Conduct clinical screening
• Authorize initial set of sessions to provider
• Check benefits for facility-based treatment
• Develop and maintain positive customer relations and coordinate with functions within the company

Skills

Customer service

Communication

Problem-solving

Facilitation

Analytical skills

Education

High school diploma or GED

Job description

Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

Primary duties may include, but are not limited to:

• Responsible for coordinating cases for precertification and prior authorization review.
• Manage 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.
• Refers cases requiring clinical review to a Nurse reviewer.
• Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
• Responds to telephone and written inquiries from clients, providers and in-house departments.
• Conducts clinical screening process.
• Authorizes initial set of sessions to provider.
• Checks benefits for facility based treatment.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

Requirements

• Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
• Medical terminology training and experience in medical or insurance field preferred.
• Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Job Type: Contract (may be extended past 3 months, but will not convert to a permanent role)

Schedule: Monday - Friday, 8:00 AM - 5:00 PM EST

This is a work from home opportunity

Must reside within 50 miles of the Tampa, Florida area and be able to commute to Tampa within approximately one hour.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.