Utilization Management Representative III

Elevance Health • Columbus, GA

3d • Remote

About The Position

Title: Utilization Management Representative III Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Utilization Management Representative III is responsible for coordinating cases for precertification and prior authorization review. How you will make an impact: Responsible for providing technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services outside of initial authorized set. Assisting management by identifying areas of improvement and expressing a willingness to take on new projects as assigned. Handling escalated and unresolved calls from less experienced team members. Ensuring UM Reps are directed to the appropriate resources to resolve issues. Ability to understand and explain specific workflow, processes, departmental priorities and guidelines. May assist in new hire training to act as eventual proxy for Ops Expert. Exemplifies behaviors embodied in the 5 Core Values. 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. Proficient in maintaining focus 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. Attentive to details, critical thinker, and a problem-solver. Demonstrates empathy and persistence to resolve caller issues completely. Comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts. Associates in this role will have a structured 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.

Requirements

• HS diploma or GED
• 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.
• 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.

Responsibilities

• Coordinating cases for precertification and prior authorization review.
• Providing technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services outside of initial authorized set.
• Assisting management by identifying areas of improvement and expressing a willingness to take on new projects as assigned.
• Handling escalated and unresolved calls from less experienced team members.
• Ensuring UM Reps are directed to the appropriate resources to resolve issues.
• Ability to understand and explain specific workflow, processes, departmental priorities and guidelines.
• May assist in new hire training to act as eventual proxy for Ops Expert.
• Exemplifies behaviors embodied in the 5 Core Values.
• Performs other duties as assigned.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees