Utilization Management Rep II at Elevance Health

West Des Moines, Iowa, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

HS diploma or equivalent
Minimum of 2 years customer service experience in a healthcare-related setting
Medical terminology training (or any combination of education and experience providing equivalent background)

Responsibilities

Manage incoming calls or incoming post services claims work, including triage, opening cases, and authorizing sessions
Determine contract and benefit eligibility; provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
Obtain intake (demographic) information from caller
Conduct a thorough radius search in Provider Finder and follow up with provider on referrals given
Refer cases requiring clinical review to a nurse reviewer; handle referrals for specialty care
Process incoming requests, collect information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization
Verify benefits and/or eligibility information
Act as liaison between Medical Management and internal departments
Respond to telephone and written inquiries from clients, providers, and in-house departments
Conduct clinical screening process

Skills

Key technologies and capabilities for this role

Customer ServiceUtilization ManagementBenefit VerificationPrior AuthorizationCase TriageProvider FinderClinical ScreeningCall ManagementHealthcare IntakeEligibility Verification

Questions & Answers

Common questions about this position

What is the work arrangement for this role?

This is a full-time virtual role allowing associates to work virtually full-time, except for required in-person training sessions. Candidates must reside in Iowa and be within a reasonable commuting distance from the posting location(s), unless an accommodation is granted.

What are the minimum requirements for this position?

Requires a HS diploma or equivalent and a minimum of 2 years customer service experience in a healthcare-related setting, plus medical terminology training, or equivalent combination of education and experience.

What skills are preferred for this role?

Preferred skills include strong oral, written, and interpersonal communication, problem-solving, facilitation, and analytical skills, along with medical terminology training, healthcare or insurance experience, and being open-minded and adaptable to evolving technologies.

What is the salary or compensation for this position?

This information is not specified in the job description.

What makes a strong candidate for this Utilization Management Rep II role?

Strong candidates will have a healthcare background with medical terminology training, 2+ years of customer service experience in healthcare, and preferred skills like excellent communication, problem-solving, facilitation, analytical abilities, plus adaptability to new technologies.

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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