Utilization Management Representative III (Georgia Only)
Elevance Health

Job Info

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Title: Utilization Management Representative III

Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our Georgia PulsePoint locations

The Utilization Management Representative III will be 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.

Minimum Requirements

• 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.

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.

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