Job Description
Utilization Management Rep II
Remote- WA OR CA UT or ID
Locations
WA-Seattle, 705 5th Ave S, Ste 300
WA-Lakewood, 10116 36th Ave Ct Sw
CA-Cerritos, 12900 Park Plaza Dr
CA-Los Angeles, 303 S Union Ave
Time Type: Full time
Job Requisition Id: JR87243
Position Title: Utilization Management Rep II -Remote- WA OR CA UT or ID
Location: REMOTE in the WA, CA, UT, OR, or ID areas
Hours: Monday-Friday 8am-5pm
A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, 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 UMRII you will be responsible for managing incoming calls, including triage, opening of cases and authorizing sessions.
How you will make an impact:
- 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.
- 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.
- Responds to telephone and written inquiries from clients, providers and in-house departments.
- Conducts clinical screening process.
Minimum Requirements:
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:
- 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.
- Certain contracts require a Master’s degree.