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Utilization Management Representative II - Colorado Springs - 80914

Company: anthem
Location: Colorado Springs
Posted on: June 12, 2021

Job Description:

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UTILIZATION MANAGEMENT REPRESENTATIVE II

Location: Colorado Springs, CO Job Family: Customer Service Req #: PS51108 Date Posted: May 24, 2021

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.

Responsible for managing incoming calls, including triage, opening of cases and authorizing sessions. Working on case management referrals for commercial accounts.

Primary duties may include, but are not limited to:

* The Utilization Management Representative II manages 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. * Verifies benefits and/or eligibility information. * 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.

Qualifications

* Requires HS Diploma or equivalent; 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. * Associates or Bachelors Degree preferred. * Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Applicable to Colorado Applicants Only

Hourly Pay Range* $15/hour - 20/hour

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

* The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. 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 Companys sole discretion, consistent with the law.

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.

Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.

Keywords: anthem, Colorado Springs , Utilization Management Representative II - Colorado Springs - 80914, Other , Colorado Springs, Colorado

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