Utilization Management Rep III-5

WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Elevance Health requires a completed online application for consideration of employment for any position. We will never ask you for a credit card, send you a check, or ask you for payment as part of consideration for employment.Utilization Management Rep III-5

Job Family: Customer Care

Type: Full time

Date Posted:Mar 22, 2024

Anticipated End Date:Apr 22, 2024

Reference: JR105545

Location:

Connecticut

Iowa

Texas

Virginia

Louisiana

Colorado

Vermont

Minnesota

Tennessee

Utah

Washington

South Dakota

Georgia

South Carolina

Michigan

Ohio

Rhode Island

Kentucky

North Dakota

Arkansas

New Jersey

Florida

District of Columbia, Washington

New York

Kansas

Delaware

New Mexico

Indiana

Arizona

Nevada

Massachusetts

Wyoming

Nebraska

Illinois

Montana

California

Idaho

North Carolina

Alabama

Hawaii

Wisconsin

Pennsylvania

Missouri

Maryland

Oregon

West Virginia

Mississippi

Maine

Oklahoma

DescriptionUtilization Management Rep IIILocation: RemoteThe Utilization Management Rep III is respo n sible for coordinating cases for precertification and prior authorization review.How you will make an impact: Primary duties may include, but are not limited to:

Responsible for providing technical guidance to UM Reps who handle correspondence.

Assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services outside of initial authorized set.

Assisting management by identifying areas of improvement and expressing a willingness to take on new projects as assigned.

Handling escalated and unresolved calls from less experienced team members.

Ensuring UM Reps are directed to the appropriate resources to resolve issues. Ability to understand and explain specific workflow, processes, departmental priorities and guidelines.

May assist in new hire training to act as eventual proxy for Ops Expert. Exemplifies behaviors embodied in the 5 Core Values.

Requirements:

Requires a HS diploma or GED and a minimum of 3 years of experience in customer service experience in healthcare related setting; or any combination of education and experience which would provide an equivalent background.

Medical terminology training required.

Preferred Skills, Capabilities and Experience:

For URAC accredited areas, the following professional competencies apply:

Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Certain contracts require a Master's degree.

For candidates working in person or remotely in the below locations, the salary range for this specific position is $19.04 to $30.06Locations: California; Colorado; HI; Nevada; New York; Washington State; Jersey City, NJIn addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Who We AreElevance 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.How We WorkAt Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates 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.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.EEO is the LawEqual Opportunity Employer / Disability / VeteranPlease use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

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