WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Elevance Health requires a completed online application for consideration of employment for any position. We will never ask you for a credit card, send you a check, or ask you for payment as part of consideration for employment.Utilization Management Representative II
Job Family: Customer Care
Type: Full time
Date Posted:Mar 08, 2024
Anticipated End Date:Apr 26, 2024
Reference: JR108675
Location:
NH, MANCHESTER
PA, SEVEN FIELDS
NV, LAS VEGAS
CA, DOWNEY
IN, INDIANAPOLIS
FL, MIAMI
PUERTO RICO, GUAYAMA
CT, ROCKY HILL
NY, BROOKLYN
CA, RANCHO CORDOVA
NY, BROOKLYN
MD, ANNAPOLIS
CA, BAKERSFIELD
CA, VISALIA
WA, LAKEWOOD
ID, MERIDIAN
NY, BROOKLYN
TX, EL PASO
MI, DEARBORN
IRELAND, CO MAYO
CA, NEW PORT BEACH
AZ, CHANDLER
PA, HERMITAGE
IN, INDIANAPOLIS
NV, LAS VEGAS
IL, SPRINGFIELD
NV, RENO
CO, DENVER
FL, SPRING HILL
FL, HIALEAH
GA, SAVANNAH
FL, HIALEAH
CA, BREA
FL, HIALEAH
FL, HIALEAH
FL, MIAMI GARDENS
FL, MIAMI
FL, MIAMI
FL, MIAMI
FL, HIALEAH
FL, MIAMI
FL, MIAMI
FL, CUTLER BAY
FL, PEMBROKE PINES
FL, MIAMI
FL, MIAMI
TX, DENISON
FL, MIAMI GARDENS
FL, NORTH MIAMI BEACH
FL, MIAMI
IA, DES MOINES
OH, CINCINNATI
NY, NEW YORK
VA, RICHMOND
CA, LOS ANGELES
CA, APPLE VALLEY
NY, Buffalo
LA, MONROE
CA, MODESTO
DC, WASHINGTON
NV, LAS VEGAS
MN, MENDOTA HEIGHTS
LA, MONROE
TN, KNOXVILLE
LA, MONROE
AZ, TUCSON
IND, KA
CA, SAN FRANCISCO
NC, MORRISVILLE
WI, MADISON
NY, ASTORIA
DE, WILMINGTON
LA, MONROE
OH, SEVEN HILLS
RI, SMITHFIELD
MA, HINGHAM
SC, GREENVILLE
CA, PLACENTIA
CA, SANTA ANA
LA, MONROE
DC, WASHINGTON
LA, MONROE
IL, DEERFIELD
LA, MONROE
VA, RICHMOND
AZ, GREEN VALLEY
KY, SHELBYVILLE
NY, BRONX
FL, ALTAMONTE SPRINGS
CA, TURLOCK
TN, MEMPHIS
CA, UPLAND
CA, WHITTIER
VA, ROANOKE
LA, MONROE
CA, LA HABRA
CA, LAWNDALE
CA, LA MIRADA
NY, NEWBURG
VA, HARRISONBURG
CA, DOWNEY
CA, SAN JOSE
LA, SHREVEPORT
NV, LAS VEGAS
LA, MONROE
LA, MONROE
CA, LA MIRADA
VA, RICHMOND
VA, RICHMOND
CA, LONG BEACH
LA, OAK GROVE
NV, LAS VEGAS
LA, MONROE
NY, EAST SYRACUSE
LA, MONROE
IL, SCHAUMBURG
VA, RICHMOND
CA, GLENDALE
MN, GILBERT
LA, METAIRIE
CA, NORWALK
PR, San Juan
NV, HENDERSON
LA, MONROE
GA, MIDLAND
LA, MANGHAM
CA, PICO RIVERA
CA, LOS ANGELES
AZ, Tucson
NC, FAYETTEVILLE
LA, MONROE
LA, MONROE
CT, WALLINGFORD
LA, MONROE
LA, HOUMA
CA, MONTEBELLO
NY, BROOKLYN
AZ, TUCSON
OH, MASON
CA, LOS ANGELES
FL, Miami
IL, CHICAGO
CO, DENVER
NV, LAS VEGAS
LA, MONROE
KY, Lexington
ME, SOUTH PORTLAND
VA, Norfolk
RI, Providence
HI, KAPOLEI
LA, LAKE CHARLES
LA, BATON ROUGE
MA, WOBURN
MA, NEWTON 55 CHAPEL ST
LA, MONROE
LA, MONROE
LA, MONROE
VA, ARLINGTON
LA, BATON ROUGE
OH, COLUMBUS
LA, NEW ORLEANS
LA, BATON ROUGE
LA, BATON ROUGE
LA, MONROE
LA, LAFAYETTE
LA, ALEXANDRIA
NC, DURHAM
FL, TAMPA
FL, ESTERO
FL, TALLAHASSEE
KS, TOPEKA
CA, WHITTIER
NY, Lake Success
CO, COLORADO SPRINGS
FL, COCONUT CREEK
NJ, LAKEWOOD
IND, HR
GA, ATLANTA
TN, MEMPHIS
OH, DUBLIN
NY, ALBANY
National +50 Miles away from nearest PulsePoint
VA, ASHBURN
Default Location for Terminated Workers
CA, SACRAMENTO
CA, WALNUT CREEK
GA, DECATUR
WA, SEATTLE
FL, NAPLES
TX, GRAND PRAIRIE
IL, CHICAGO
TX, AUSTIN
MI, DEARBORN
PR, MANATI
TN, NASHVILLE
GA, JASPER
TN, NASHVILLE
MO, ST. LOUIS
NY, JACKSON HEIGHTS
PR, GUAYAMA
PR, MAYAGUEZ
PR, PONCE
TX, HOUSTON
MO, KANSAS CITY
VA, CHESAPEAKE
TX, CONROE
VA, NORFOLK
TN, MURFREESBORO
PR, OROCOVIS
CO, GREENWOOD
CA, LOS ANGELES
MO, ST LOUIS
MD, HANOVER
PR, SAN JUAN
VA, Virginia Beach
CA, Cypress
PR, SAN GERMAN
NJ, ISELIN
NY, BROOKLYN
NY, BRONX
MO, OVERLAND
NY, COLLEGE POINT
FL, CAPE CORAL
NY, STATEN ISLAND
NY, QUEENS
PR, GUAYNABO
NY, BROOKLYN
PR, HATILLO
TX, NORTH RICHLAND HILLS
PR, VIEQUES
TX, SUGAR LAND
NY, BROOKLYN
PR, SAN JUAN
AL, HUNTSVILLE
NY, FLUSHING
PR, ARECIBO
TX, HOUSTON
PR, AGUADILLA
TX, DALLAS
PR, SAN JUAN
AL, BIRMINGHAM
NY, SOUTH RICHMOND HILL
PR, MAYAGUEZ
NE, OMAHA
PR, HUMACAO
PR, FAJARDO
GA, AUGUSTA
PR, ARECIBO
PR, CAROLINA
IA, W DES MOINES
NE, NORFOLK
TX, ROUND ROCK
MO, INDEPENDENCE
PR, MANATI
TX, COPPELL
TX, LUBBOCK
PR, HUMACAO
PR, GUAYAMA
PR, SAN JUAN
TX, SAN ANTONIO
MA, BOSTON
PR, GUAYNABO
GA, SANDY SPRINGS
NY, HEMPSTEAD
TX, WACO
FL, Miami
OK, OKLAHOMA CITY
PR, SAN JUAN
FL, VENICE
MO, ST. LOUIS
PR, CAROLINA
FL, PLANTATION
FL, FORT MYERS
PR, CABUAS
NC, ASHEVILLE
FL, LARGO
FL, ORANGE CITY
PR, AIBONITO
PR, AGUADILLA
NY, NEW YORK
FL, SARASOTA
FL, LAUDERDALE LAKES
GA, SMYRNA
FL, MIAMI
TX, WEBSTER
CO, DENVER
LA, DENHAM SPRINGS
MI, WIXOM
TX, CORPUS CHRISTI
AL, MONTGOMERY
FL, MIAMI
PHL ILO One Fintech Place
TX, BEE CAVE
PR, PONCE
NC, DURHAM
PR, COAMO
NE, LINCOLN
TX, SAN ANTONIO
TN, BRENTWOOD
NJ, PATERSON
Limerick, Clive House
FL, HOLLYWOOD
IND, KA
MO, CAPE GIRARDEAU
PR, CAROLINA
TX, BELLAIRE
CA, HOLLISTER
CO, ENGLEWOOD
IND, TG
MO, SPRINGFIELD
PR, GUAYAMA
FL, DELRAY BEACH
MO, COLUMBIA
PR, CANOVANAS
VA, ASHBURN
MO, ST JOSEPH
PR, CAGUAS
OH, COLUMBUS
PR, BAYAMON
MS, JACKSON
NC, CARY
NE, KEARNEY
TX, SAN ANGELO
NE, LINCOLN
PR, GUAYAMA
TX, KYLE
PR, SAN JUAN
PR, BAYAMON
PR, SAN JUAN
NE, SCOTTSBLUFF
PR, SAN JUAN
ID, MERIDIAN
CA, LOS ANGELES
PR, BAYAMON
TX, PLANO
TX, HOUSTON
FL, CLEARWATER
NC, WINSTON
AL, MONTGOMERY
GA, ATLANTA
TX, FORT WORTH
CA, ALHAMBRA
TX, AUSTIN
FL, W PALM BEACH
CA, FULLERTON
NY, BROOKLYN
AZ, TUCSON
Tel Aviv, Yafo
FL, NEW PORT RICHEY
NC, RALEIGH
FL, FORT PIERCE
AZ, TUCSON
TX, PLANO
FL, LARGO
NV, LAS VEGAS
TX, AUSTIN
FL, ORLANDO
TN, KNOXVILLE
FL, OCALA
TX, EL PASO
CA, W COVINA
FL, MIAMI
FL, TAMPA
FL, MIAMI
FL, TAMPA
CA, WOODLAND HILLS
FL, JACKSONVILLE
MD, BALTIMORE
NJ, MORRISTOWN
WI, Waukesha
FL, PEMBROKE PINES
TX, SAN ANTONIO
MO, JEFFERSON CITY
FL, HIALEAH
TX, EL PASO
OR, Beaverton
OH, MASON
PHL NCR Taguig City Alliance Global Tower
PHL NCR Pasig City Glas Tower
KY, LOUISVILLE
TN, KNOXVILLE
PHL ILO SM Strata
TX, SAN ANTONIO
GA, ATLANTA
TX, ARLINGTON
VA, CHESAPEAKE
PR4241, Puerto Rico
NY, MIDDLETOWN
MO, Jefferson City
AZ, Phoenix
TX, KATY
AR, LITTLE ROCK
TN, HENDERSONVILLE
GA, ALPHARETTA
CA, Downey
DC, WASHINGTON
CA, HACIENDA HEIGHTS
AZ, TUCSON
CA, SAN JOSE
CA, COSTA MESA
TX, LUBBOCK
FL, TAMPA
CA, SAN FRANCISCO
FL, MIAMI
KS, TOPEKA
CA, CERRITOS
PUERTO RICO, CAGUAS
FL, Hialeah
FL, KISSIMMEE
CA, WHITTIER
PA, HARRISBURG
CA, PALO ALTO
TX, FORT WORTH
NY, LATHAM
DC, WASHINGTON
PUERTO RICO, SAN JUAN
OH, COLUMBUS
TX, HOUSTON
CA, APPLE VALLEY
PUERTO RICO, CAROLINA
AZ, TUCSON
CO, Colorado Springs
DescriptionUtilization Management Representative IILocation: RemoteA 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.We are looking for candidates to work on the Behavioral Health Help Line with experience in mental health/substance use crisis, assessment and referral.The Utilization Management Representative II is responsible for managing incoming calls, including triage, opening of cases and authorizing sessions.We operate 24 hours a day, 7 days a week, 365 days out of the year. This is a 24-hour call center, open 365 days, with varied 1st, 2nd, and 3rd shifts to include weekends. Training is Monday-Friday 10a-6p EST.How you will make an impact:
Responsible for providing technical guidance to UM Reps who handle correspondence.
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.
Requirements:
Requires a HS diploma or GED and a minimum of 2 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.
Preferred Skills, Capabilities and Experience:
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.
For candidates working in person or remotely in the below locations, the salary range for this specific position is $15.56-$24.58Locations: California; Colorado; HI; Nevada; New York; Washington State; Jersey City, NJIn addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Who We AreElevance 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, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.How We WorkAt Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.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.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, 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@elevancehealth.com for assistance.EEO is the LawEqual Opportunity Employer / Disability / VeteranPlease use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.
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Elevance Health, Inc. is anE-verify Employer (https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)Need Assistance?Email us (elevancehealthjobssupport@elevancehealth.com)
Full-time