Utilization Management Rep I (US)
Elevance Health

Answers incoming telephone calls and initiates precertification/case management requests from providers/members.

Ensures precertification requirements are met and explains policies to customers as applicable

Processes incoming faxes, phone calls and voicemails.

Requests medical records for clinical updates and conducts call backs to confirm admit/discharge dates.

Electronically processes, files, and submits faxed clinical information submitted by providers.

Documents in Medical Management and claims software.

Meets call monitoring quality standards

Follows standardized phone usage and meets goals and standards for all AUX functions

Completes outbound calls to providers and members as needed

Meets or exceed department agent call metrics

Participates in and completes projects in a timely and accurate manner.

Ensures timely turn around and accuracy to comply with UM licensing requirements and accreditation standards.

Protects and enhances the daily culture and environment of AmeriBen. Fosters, support, and demonstrates the company Core Purpose and Core Values.

Attends weekly Leadership Forum/Company View, conducts team meetings, and participates in monthly staff meetings.

Ensure compliance with security practices and procedures, including HIPAA and HITRUST standards.

Performs other duties as assigned or needed.