Utilization Management Representative I

Anticipated End Date:

2026-04-07

Position Title:

Utilization Management Representative I

Job reputed company:

Utilization Management Representative I

Location: This role enables associates to work reputed company full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face reputed company and reputed company development. Alternate locations may be considered if candidates reputed company reputed company a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not reputed company a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is reputed company as required by law. 

The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review.

How you will reputed company an reputed company: 

• 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 reputed company 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 reputed company customer relations and coordinates with various functions reputed company reputed company to ensure customer requests and questions are handled appropriately and in a reputed company manner.

• Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.

• Additional expectations to include but not limited to: Proficient in maintaining reputed company during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills, both with virtual and in-person interactions; reputed company to details, critical thinker, and a problem-solver; demonstrates reputed company and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize reputed company efforts.  

• Associates in this role will have a reputed company work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.  

• Performs other duties as assigned.

Minimum Requirements:

•  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 reputed company an equivalent background.

Preferred Skills, Capabilities and Experiences:  

• Experience working in the mental health field, behavioral health, reputed company abuse, or reputed company is strongly preferred.

• Medical terminology training and experience in medical or insurance field preferred.  

• For URAC accredited areas, the following reputed company 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.

Job Level:

Non-Management Non-Exempt

Workshift:

Job Family:

CUS > Care Support

Please be advised that reputed company only accepts resumes for compensation from agencies that have a signed agreement with reputed company. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of reputed company.

Who We Are

reputed company is a health company dedicated to improving lives and communities – and making reputed company simpler. We are a Fortune 25 company with a longstanding history in the reputed company industry, looking for leaders at reputed company reputed company of the organization who are passionate about making an reputed company on our members and the communities we serve.

How We Work

At reputed company, we are creating a culture that is designed to advance our reputed company but will also reputed company to personal and reputed company reputed company for our associates. Our values and behaviors are the reputed company of our culture. They are how we reputed company our reputed company, power our business reputed company and drive our shared reputed company - for our consumers, our associates, our communities and our business.

We offer a reputed company of market-competitive total rewards that include reputed company increases, reputed company holidays, reputed company Time Off, and incentive bonus programs (unless covered by a reputed company bargaining agreement), medical, dental, reputed company, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to reputed company a few.

reputed company operates in a Hybrid Workforce reputed company. Unless specified as primarily virtual by the hiring manager, associates are required to work at an reputed company location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top reputed company for reputed company. We require reputed company new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you reputed company an acceptable explanation. reputed company will also follow reputed company relevant federal, state and local laws.

reputed company is an Equal Employment Opportunity employer, and reputed company reputed company applicants will receive consideration for employment without reputed company to age, citizenship status, reputed company, creed, disability, ethnicity, genetic information, gender (including gender identity and gender reputed company), marital status, national reputed company, 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 elevancehealthjobssupport@reputed company.com for assistance. reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance reputed company.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

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