Utilization Management Representative I at Elevance Health in Indianapolis, Indiana

Posted in Other about 18 hours ago.





Job Description:

Title: Utilization Management Representative I




Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.


The Utilization Management Representative I will be responsible for coordinating cases for precertification and prior authorization review.



How you will 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.

  • Refers cases requiring clinical review to a Nurse reviewer.

  • Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.

  • Responds to telephone and written inquiries from clients, providers and in-house departments.

  • Conducts clinical screening process.

  • Authorizes initial set of sessions to provider.

  • Checks benefits for facility based treatment.

  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.




Minimum 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.




Preferred Skills, Capabilities and Experiences



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


More jobs in Indianapolis, Indiana

Other
about 1 hour ago

Eskenazi Health
Other
about 1 hour ago

Cribl
Other
about 1 hour ago

Beacon Hill Staffing Group, LLC
More jobs in Other

Other
less than a minute ago

Haven Behavioral Healthcare
Other
less than a minute ago

Haven Behavioral Healthcare
Other
less than a minute ago

Haven Behavioral Healthcare