at Elevance Health in Chicago, Illinois, United States
Job Description
A 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.
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review.
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.
+ Refers cases requiring clinical review to a Nurse reviewer.
+ Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
+ Responds to telephone and written inquiries from clients, providers and in-house departments.
+ Conducts clinical screening process.
+ Authorizes initial set of sessions to provider.
+ Checks benefits for facility based treatment.
+ Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
Minimum Requirements:
+ Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
+ Medical terminology training and experience in medical or insurance field preferred.
+ Behavioral health experience strongly preferred.
+ BH prior authorization experience strongly 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.
