Utilization Management Representative Lead

Anticipated End Date:

Position Title:

Job Description:

Utilization Management Representative Lead

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.

Hours: 8:35 AM to 5:05 PM Pacific

The Utilization Management Representative Lead is responsible for providing technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for precertification prior authorization of inpatient and outpatient services and post service requests.

How you will make an impact:

• Motivates and encourages UM Reps while providing technical guidance.
• Provides quality control services such as call monitoring and conducts UMR level I II and III audits for subsequent performance under NMIS and MTM standards.
• Suggests methods to improve productivity.
• Understands specific workflow processes departmental priorities and guidelines.
• Monitors daily phone activities to exceed NMIS standards and improve customer service levels.
• Assists in supervising the daily activities of a group of Behavioral Health Associates.
• Provides direction and guidance to less experienced team members.
• Assists manager with PTO scheduling and monitoring attendance.
• Handles escalated and unresolved calls from less experienced team members.
• Handles complex situations and ensures UM Reps are directed to the appropriate resources to resolve issues.
• Keeps team members informed of any changes.
• Assists management by identifying areas of improvement and recommends solutions.
• Keeps manager informed of changes or problems.
• Keeps departmental manuals up-to-date.
• Researches resources for report generation for manager and ancillary departments.
• Obtains analyzes and presents statistical information as it relates to units of work productivity FTEs at work and time off.
• May provide input into hiring decisions and performance appraisals.

Minimum Requirements:

• Requires HS diploma or equivalent and a minimum of 5 years related experience to include complex customer service or call center experience and medical terminology training; or any combination of education and experience which would provide an equivalent background.

Preferred Skills Capabilities and Experiences:

• Knowledge of health plans including familiarity with prior authorization and precertification process; knowledge of contracts and strong knowledge of managed benefit programs strongly preferred.
• Reporting presentation training and leadership experience strongly preferred.
• Microsoft Excel experience strongly preferred.
• Certain contracts require a Masters degree.
• 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.

For candidates working in person or virtually in the below locations the salary* range for this specific position is $23.38 to $40.09

Locations:

California Nevada Washington

In 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 Companys sole discretion unless and until paid and may be modified at the Companys sole discretion consistent with the law.

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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.