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Utilization Management Representative IIElevance Health • Miami, Florida, United States
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Utilization Management Representative II

Elevance Health
  • US
    Miami, Florida, United States
  • US
    Miami, Florida, United States
Jetzt Bewerben

Über

Utilization Management Representative II Location: The selected candidate for this position must reside in Lake Mary, Tampa or Miami Florida. Hours: Must be available to work 4 days between Monday - Friday from 12 pm - 9 pm EST + one weekend day per week (to include a 10% shift differential). Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. The Utilization Management Representative II is responsible for managing incoming calls, including triage, opening of cases and authorizing sessions. How will you make an impact:
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.
Minimum Requirements:
Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Qualifications:
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. Medical terminology training and experience in medical or insurance field preferred. Open-minded and adaptable to evolving technologies Versatile and able to manage multiple responsibilities Background in healthcare with training in medical terminology Experience in the medical or insurance field Excellent problem-solving, facilitation, and analytical skills
Job Level: Non-Management Non-Exempt Workshift: 2nd Shift (United States of America) Job Family: CUS > Care Support
  • Miami, Florida, United States

Sprachkenntnisse

  • English
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