SHIFT: Day Job
SCHEDULE: Full-time

Utilization Management Rep III

Remote - Anywhere in the US; This is a 24/7/365 crisis center operation with varied 1st, 2nd, and 3rd shifts to include weekends. Training is full time Monday - Friday 10 am - 6 pm EST/9 am - 5 pm CST

*****$500 Sign On Bonus Offered*****

Be part of an extraordinary teamWe are looking for leaders at all levels of the organization who are passionate about making an impact on our members and thecommunities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purposeand an evolving, high-performance culture that empowers you to make an impact?

Build the Possibilities. Make an extraordinary impact. Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care. Beacon Health Options is a proud member of the Anthem Inc family of companies. As a Utilization Management Representative, you will be responsible for managing incoming calls, including triage, opening of cases, and authorizing sessions. This is a 24 hour crisis center, open 365 days, with varied 1st, 2nd, and 3rd shifts to include weekends.

How you will make an impact:

• Manage incoming calls or post services claims work
• Determine contract and benefit eligibility
• Provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
• Obtains intake (demographic) information from caller
• Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given
• 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, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization
• Verifies benefits and/or eligibility information
• May act as liaison between Medical Management and internal departments
• Responds to telephone and written inquiries from clients, providers and in-house departments
• Conducts clinical screening process

Qualifications

This position can be filled at the Utilization Management Representative I, II, or III level. The hiring manager will determine the level, based on the candidate’s experience and background.

Level I

• Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
• Medical terminology training and experience in medical or insurance field preferred.

Level II

• Requires 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.

Level III

• 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 qualifications

• Bachelor's strongly preferred
• Master's degree a plus
• Mental health, substance abuse, and or crisis line assessments experience strongly preferred
• Experience working on a text/chat platform completing assessments preferred
• De-escalation skills
• Motivational interviewing or similar skills
• Strong oral, written and interpersonal communication skills
• Problem-solving skills

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.
Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will Ireceive 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 ability@icareerhelp.com for assistance.