Overview Join to apply for the Utilization Management Representative II role at CareBridge
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This range is provided by CareBridge. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range $19.00/hr - $31.09/hr
Location and schedule Location: Virtual: This role enables associates to work virtually full-time in CALIFORNIA, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
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.
Responsibilities The Utilization Management Representative II is responsible for conducting service coordination functions for a defined caseload of individuals
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; 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 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 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
Locations Locations: California
Equal Opportunity and employment information 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.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Company information and culture Seniority level
Entry level
Employment type
Contract
Job function
Health Care Provider
Industries
Hospitals and Health Care
Note: The description may include referrals to increase interview opportunities.