Utilization Management Representative III
| Company | Elevance Health |
|---|---|
| Location | Durham, NC, USA, Richmond, VA, USA, Ashburn, VA, USA, Winston-Salem, NC, USA, Norfolk, VA, USA, Roanoke, VA, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | |
| Experience Level | Mid Level |
Requirements
- Requires a HS diploma or GED and a minimum of 3 years of experience in customer service experience in healthcare related setting; or any combination of education and experience which would provide an equivalent background.
- Medical terminology training required.
- For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Responsibilities
- Responsible for providing technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services outside of initial authorized set.
- Assisting management by identifying areas of improvement and expressing a willingness to take on new projects as assigned.
- Handling escalated and unresolved calls from less experienced team members.
- Ensuring UM Reps are directed to the appropriate resources to resolve issues.
- Ability to understand and explain specific workflow, processes, departmental priorities and guidelines.
- May assist in new hire training to act as eventual proxy for Ops Expert.
- Exemplifies behaviors embodied in the 5 Core Values.
Preferred Qualifications
- Experience using the AUMI and Genesys Cloud systems.
- Behavioral health based medical terminology and experience preferred.