Utilization Management Representative I at Elevance Health

Latham, New York, United States

Apply Now

Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

HS diploma or GED
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
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills (for URAC accredited areas)

Responsibilities

Coordinate cases for precertification and prior authorization review
Manage incoming calls or incoming post services claims work
Determine contract and benefit eligibility; provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
Refer cases requiring clinical review to a Nurse reviewer
Identify and data enter referral requests into the UM system in accordance with the plan certificate
Respond to telephone and written inquiries from clients, providers and in-house departments
Conduct clinical screening process
Authorize initial set of sessions to provider
Check benefits for facility based treatment
Develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner

Skills

Key technologies and capabilities for this role

Customer ServiceCall CenterUtilization ManagementPrecertificationPrior AuthorizationMedical TerminologyBenefit EligibilityClinical ScreeningData Entry

Questions & Answers

Common questions about this position

What is the salary range for this position?

For candidates working in New York, the salary range is $16.33/hr to $24.50/hr. The actual compensation may vary based on legitimate factors.

Is this a remote position?

This is a virtual full-time role with maximum flexibility, except for required in-person training sessions. Candidates must be within a reasonable commuting distance from the posting location(s), unless an accommodation is granted.

What are the minimum requirements for this role?

A high school diploma or GED is required, along with a minimum of 1 year of customer service or call-center experience, or equivalent education and experience.

What benefits does Elevance Health offer?

Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution, all subject to eligibility requirements.

What preferred skills make a candidate stronger for this role?

Medical terminology training and experience in the medical or insurance field are preferred.

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.

Land your dream remote job 3x faster with AI

Try Jobo Free