Utilization Management Representative
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. Beacon Health Options is a proud member of the Elevance Health family of companies. As a Utilization Management Representative, you will be responsible for managing incoming calls, including triage, opening of cases, and authorizing sessions.
How you will make an impact:
- Manage incoming calls or post services claims work
- Determine contract and benefit eligibility
- Provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
- Obtain intake (demographic) information from caller
- Conduct a thorough radius search in Provider Finder and follow up with provider on referrals given
- Refers cases requiring clinical review to a nurse reviewer; handle referrals for specialty care
- Process incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization
- Verify benefits and/or eligibility information.
- May act as liaison between Medical Management and internal departments
- Respond to telephone and written inquiries from clients, providers, and in-house departments
- Conduct clinical screening process
Here’s what Elevance Health offers:
- A career path with opportunity for growth
- Ability to obtain your Associates’ or Bachelor’s degree or further your education with tuition reimbursement
- Affordable Health Insurance, Dental, Vision, and Basic Life
- 401 K Match, Paid Time Off, Holiday Pay
- Quarterly incentive bonus and annual increases plan based on performance.
At Elevance Health, the team is comprised of the best and brightest from diverse experiences, cultures, and backgrounds. The differences we each bring to the table are a part of what makes our company so successful.
This position can be filled at Utilization Management Representative I or Utilization Management Representative II, or Utilization Management Representative III. The hiring manager will determine the level, based on the candidate’s experience and background
- Level I: Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
- Level II: 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.
- Level III: 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.
- Certain contracts require a master’s degree.
Preferred Skills, Capabilities and Experiences:
- Bachelor’s degree in Social Work
- Medical terminology training, time management skills, organizational skills
- Experience in medical setting, insurance, or behavioral health.
- Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
*** For candidates working in person or remotely in the below locations, the salary* range for this specific position is $15.07 to $29.42
Locations: California, Colorado, Nevada, and Washington,
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The 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. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. 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.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact email@example.com for assistance.