Utilization Management Representative I at Elevance Health in Indianapolis, Indiana

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.

• 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.