Utilization Management Rep III

Afterhours Utilization Management Representative III   Location : This role enables associates to work virtually full-time, except for 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. Alternate locations may be considered if candidates reside within a commuting distance from an office.   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 accommodation is granted as required by law.   Hours : Friday through Monday - 10 hour shifts covering between 6:30am to 11pm Eastern time. Please adjust for your time zone. The Afterhours Utilization Management Representative III is responsible for coordinating cases for precertification and prior authorization review.   How you will make an impact: Responsible for providing technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services outside of initial authorized set.   Assisting management by identifying areas of improvement and expressing a willingness to take on new projects as assigned. Handling escalated and unresolved calls from less experienced team members.   Ensuring UM Reps are directed to the appropriate resources to resolve issues. Ability to understand and explain specific workflow, processes, departmental priorities and guidelines. May assist in new hire training to act as eventual proxy for Ops Expert. Exemplifies behaviors embodied in the 5 Core Values.   Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers. Additional expectations to include but not limited to: Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills, both with virtual and in-person interactions; attentive to details, critical thinker, and a problem-solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.   Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.   Performs other duties as assigned.

Requires a HS diploma or GED and a minimum of 3 years of experience in customer service experience in healthcare related setting; or any combination of education and experience which would provide an equivalent background. Medical terminology training required.   Preferred Skills, Capabilities and Experiences:  Experience in a call center / call queue environment strongly preferred.  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. Job Level: Non-Management Non-Exempt Workshift: 2nd Shift (United States of America) Job Family: CUS > Care Support 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.

Elevance Health is a health company dedicated to improving lives and