Utilization Management Rep I (US) at Elevance Health in Meridian, Idaho

Job Description:

Answers incoming telephone calls and initiates precertification/case management requests from providers/members.


Ensures precertification requirements are met and explains policies to customers as applicable


Processes incoming faxes, phone calls and voicemails.


Requests medical records for clinical updates and conducts call backs to confirm admit/discharge dates.


Electronically processes, files, and submits faxed clinical information submitted by providers.


Documents in Medical Management and claims software.


Meets call monitoring quality standards


Follows standardized phone usage and meets goals and standards for all AUX functions


Completes outbound calls to providers and members as needed


Meets or exceed department agent call metrics


Participates in and completes projects in a timely and accurate manner.


Ensures timely turn around and accuracy to comply with UM licensing requirements and accreditation standards.


Protects and enhances the daily culture and environment of AmeriBen. Fosters, support, and demonstrates the company Core Purpose and Core Values.


Attends weekly Leadership Forum/Company View, conducts team meetings, and participates in monthly staff meetings.