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Utilization Management Rep II - St Louis, United States - Elevance Health
Description
Utilization Management Rep IILocation:
This is a remote opportunity. Candidates can reside anywhere in the US buts must be willing to work 8:30-5:00 PST hours.
BioPlus Specialty Pharmacy is now part of CarelonRx (formerly IngenioRx), and a proud member of the Elevance Health family of companies.
Together, CarelonRx and BioPlus offer consumers and providers an unparalleled level of service that's easy and focused on whole health.
Through our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer's treatment journey.
The Utilization Management Rep II is responsible for managing incoming calls, including triage, opening of cases and authorizing sessions.How you will make an impact:
Managing incoming calls or incoming post services claims work.
Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests. Obtains intake (demographic) information from caller.
Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given.
Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care.
Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization.
May act as liaison between Medical Management and internal departments. Responds to telephone and written inquiries from clients, providers and in-house departments.
Conducts clinical screening process.
Minimum Qualifications:
Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
Experience in prior authorizations for infusion preferred.
Experience with IVIG preferred.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $16.38 to $30.71/hour.
Locations:
California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ
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 Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
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