Utilization Management Representative III

Anticipated End Date:

Position Title:

Job Description:

Utilization Management Representative III

Location:This role requires associates to be in-office 5 days per week at our San Antonio TX location.

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.

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.
• Medical terminology training required.

Preferred Skills Capabilities and Experiences:

• Minimum of3years of experience in healthcare or pharmacy services with specific experience with pharmacy adjudication and prior authorizations strongly preferred.
• Knowledge of the 340B program and experience with specialty medications strongly preferred
• Certified Pharmacy Technician (CPhT) or related certification preferred.
• Strong organizational and multitasking skills with meticulous attention to detail and problem-solving skills preferred.
• Excellent communication and interpersonal skills to liaise effectively with prescribers pharmacy staff and insurance companies preferred.
• Proficiency in using healthcare information systems and Microsoft Office applications preferred.
• 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 Masters degree.

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Workshift:

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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 Are

Elevance 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 Work

At 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.

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 and Influenza. 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 for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.