Utilization Management Specialist II: Prior Authorization

Elevance Health (Anthem); San Antonio (TX); On-site; USD 52,000 - 68,000; Full time

Job summary

Elevance Health in San Antonio is seeking an Utilization Management Representative II to handle incoming calls, verify eligibility, and authorize inpatient admissions or precertifications in a timely manner. You will conduct clinical screening, coordinate with providers, and reference Provider Finder for referrals, supporting care teams and ensuring compliant, quality reviews.

This 1st shift, non-management role requires a HS diploma and healthcare customer service experience; it offers

Qualifications

• Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training
• Knowledge of health plans, including familiarity with prior authorization and precertification process; strong knowledge of managed benefit programs preferred
• Prior experience with prior-authorization management is strongly preferred.

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

Communication skills

Prior authorization knowledge

Education

HS diploma or equivalent

Job description

Elevance Health in San Antonio is seeking an Utilization Management Representative II to handle incoming calls, verify eligibility, and authorize inpatient admissions or precertifications in a timely manner. You will conduct clinical screening, coordinate with providers, and reference Provider Finder for referrals, supporting care teams and ensuring compliant, quality reviews.

This 1st shift, non-management role requires a HS diploma and healthcare customer service experience; it offers