Join to apply for the Utilization Management Representative II role at CareBridge
Base pay range
$19.00/hr - $31.09/hr
Location: Virtual – This role enables associates to work virtually full-time in California, with the exception of required in-person training sessions.
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: Monday - Friday, an 8‑hour shift between 8 am - 5 pm PST.
How will you make an impact
Managing incoming calls
Determine contract and benefit eligibility; creates authorizations for LTSS members.
Obtains intake (demographic) information from LTSS providers.
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.
Verifies benefits and/or eligibility information.
May act as a liaison between LTSS and internal departments.
Responds to telephone and written inquiries from providers and in‑house departments.
Manages non‑clinical needs of members with chronic illnesses, co‑morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long‑term services and supports.
May also serve as mentor, subject matter expert or preceptor for new staff, assisting the formal training of associates, and may be involved in process improvement initiatives.
Minimum Requirements
Requires HS diploma or equivalent and a minimum of 2 years customer service experience in a healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities And Qualifications
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.
Previous experience working in a social work setting preferred.
BA/BS degree is preferred in the field of health care.
Specific education, years and type of experience may be required based upon state law and contract requirements.
Travel to worksite and other locations when necessary.
For candidates working in person or virtually in the below location(s), the salary range for this specific position is $19.00 to $31.09.
Seniority level
Entry level
Employment type
Contract
Job function
Health Care Provider
Hospitals and Health Care
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 elevancehealthjobssupport@elevancehealth.com for assistance.