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Utilization Management Representative I - Norfolk - 23530

Company: anthem
Location: Norfolk
Posted on: June 7, 2021

Job Description:

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UTILIZATION MANAGEMENT REPRESENTATIVE I

Location: Norfolk, VA Job Family: Customer Service Req #: PS51304 Date Posted: May 27, 2021

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, its a powerful combination. Its 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.

Responsible for coordinating cases for precertification and prior authorization review.

Primary duties may includes, but are not limited:

* 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. * This is a call center environment.

Qualifications

* Requires High school diploma/GED; 1 year of customer service or call-center experience; proficient analytical, written and oral communication skills; or any combination of education and experience, which would provide an equivalent background. * Medical terminology training and experience in medical or insurance field preferred. * For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

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. has been named as a Fortune 100 Best Companies to Work For, is ranked as one of the 2020 Worlds Most Admired Companies among health insurers by Fortune magazine, and a 2020 Americas 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, Norfolk , Utilization Management Representative I - Norfolk - 23530, Other , Norfolk, Virginia

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