Overview Anticipated End Date: 2025-11-08
Position Title: Utilization Management Representative Lead
Job Description: Utilization Management Representative Lead
This role enables associates to work virtually full-time, 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: 8:35 AM to 5:05 PM Pacific
Job Family: CUS > Care Support
Job Level: Non-Management Non-Exempt
Workshift:
Locations: California, Nevada, Washington
Who We Are / How We Work: Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company seeking leaders at all levels who are passionate about making an impact on our members and the communities we serve.
How We Work: We are creating a culture that supports strategy, growth, and success for our consumers, associates, communities and business. We offer a range of market-competitive total rewards and a hybrid workforce strategy. Specific onsite requirements will be discussed during the hiring process. Vaccination requirements may apply for certain patient/member-facing roles in accordance with applicable laws.
Equal Opportunity: Elevance Health is an Equal Employment Opportunity employer. Applicants will be considered without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by law. If accommodation is needed during the application process, contact the provided support channel for assistance.
Responsibilities Provides technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for precertification, prior authorization of inpatient and outpatient services, and post-service requests.
Motivates and encourages UM Reps while providing technical guidance.
Provides quality control services such as call monitoring and conducts UMR level I, II, and III audits for subsequent performance under NMIS and MTM standards.
Suggests methods to improve productivity.
Understands specific workflow, processes, departmental priorities and guidelines.
Monitors daily phone activities to exceed NMIS standards and improve customer service levels.
Assists in supervising the daily activities of a group of Behavioral Health Associates.
Provides direction and guidance to less experienced team members.
Assists manager with PTO scheduling and monitoring attendance.
Handles escalated and unresolved calls from less experienced team members.
Handles complex situations and ensures UM Reps are directed to the appropriate resources to resolve issues.
Keeps team members informed of any changes.
Assists management by identifying areas of improvement and recommends solutions.
Keeps manager informed of changes or problems.
Keeps departmental manuals up-to-date.
Researches resources for report generation for manager and ancillary departments.
Obtains, analyzes and presents statistical information as it relates to units of work, productivity, FTEs at work and time off.
May provide input into hiring decisions and performance appraisals.
Qualifications Minimum Requirements: Requires HS diploma or equivalent and a minimum of 5 years related experience to include complex customer service or call center experience and medical terminology training; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences: Knowledge of health plans, including familiarity with prior authorization and precertification process; knowledge of contracts and strong knowledge of managed benefit programs strongly preferred. Reporting, presentation, training, and leadership experience strongly preferred. Microsoft Excel experience strongly preferred. Certain contracts require a Master\'s degree. For URAC accredited areas, associates are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Compensation Salary range: $23.38 to $40.09 per hour for candidates working in person or virtually in the listed locations. The salary offered is based on various factors including geographic location, experience, education, and skill level. Elevance Health reserves the right to modify the range in the future. Benefits and bonuses are described in the posting but subject to eligibility and company policies.
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. The actual compensation may vary and is not a guaranteed wage until earned. Any bonus, commissions, benefits, or other compensation are at the company's discretion as permitted by law.
Additional Details Job Level: Non-Management Non-Exempt