Build the Possibilities. Make an extraordinary impact.
Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care. As a Utilization Management Representative, you will be responsible for managing incoming calls, including triage, opening of cases, and authorizing sessions. This is a 24 hour call center, open 365 days, with varied 1st, 2nd, and 3rd shifts to include weekends.
How you will make an impact:
- Manage incoming calls
- Determine contract and benefit eligibility
- Provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
- Obtains intake (demographic) information from caller
- Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given
- Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care
- Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization
- Verifies benefits and/or eligibility information
- May act as liaison between Medical Management and internal departments
- Conducts clinical screening process
Level II :
- Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences
- Bachelor's degree is STRONGLY preferred
- Crisis line or mental healthcare experience very strongly preferred
- Experience working on a phone/text/chat platform completing assessments preferred
- Master’s Degree preferred
- De-escalation skills
- Motivational interviewing or similar skills
- Strong oral, written and interpersonal communication skills
- Problem-solving skills
Applicable to Colorado Applicants Only
Hourly Pay Range*: $16.13/hr - $23.17/hr (Min – MRP)
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
* The hourly or salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.