Utilization Management Representative III
Posted 1 month ago Expired
This job has expired
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Upload Your ResumeAbout This Role
The Utilization Management Representative III coordinates cases for precertification and prior authorization review, provides technical guidance to less experienced representatives, and assists management in identifying areas for improvement.
Responsibilities
- Provide technical guidance to UM Reps handling correspondence and assisting callers with contract/benefit eligibility issues for pre-certification and prior authorization.
- Assist management by identifying areas of improvement and taking on new projects.
- Handle escalated and unresolved calls from less experienced team members.
- Ensure UM Reps are directed to appropriate resources to resolve issues.
- Understand and explain specific workflow, processes, departmental priorities, and guidelines.
- Assist in new hire training, acting as an eventual proxy for Ops Expert.
- Perform other duties as assigned.
Requirements
- HS diploma or GED
- Minimum of 3 years of experience in customer service in healthcare related setting
- Medical terminology training
Qualifications
- HS diploma or GED
- Minimum of 3 years of experience in customer service in a healthcare-related setting; or any combination of education and experience which would provide an equivalent background.
Skills
* Required skills
Benefits
About Elevance Health
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry.