Job Description

Utilization Manager Correspond Representative Sr

Location : Remote

Hours : 12pm-8 : 30am EST Monday-Friday

Utilization Manager Correspond Representative Sr is responsible for processing and generating letters for services denied by the Utilization Management (UM) Medical Director within established Centers for Medicare and Medicaid Services (CMS) guidelines.

How you will make an impact :

• Completes denial letters for services denied by Medical Director.
• Maintains updated denial letter templates.
• Generates and prints denial letters for mailing.
• Participates in department workgroups to improve processes and procedures.
• Provides feedback to ensure denials are handled according to CMS standards.
• Collaborates with other departments to produce letters for services denied in their respective units.
• Answers and routes incoming calls from providers, medical groups, and others verifying referral status.

Requirements :

HS diploma and a minimum of 2 years of experience as a UM Correspondence Rep and a minimum of 2 years of previous experience in a related field;

or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experience :

Knowledge of the UM patient referral process, eligibility, benefits and Health Plan regulations, HMO / UM functions, ICD-9 / CPT coding strongly preferred.

For candidates working in person or remotely in the locations below, the hourly* range for this specific position is $17.20 to $25.80.

Locations : California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ

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.

Job Level :

Non-Management Non-Exempt

Workshift : Job Family :

Job Family : CUS >

CUS >

Service Operations

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.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week.

Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient / member-facing roles to become vaccinated against COVID-19.

If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive 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 for assistance.

Last updated : 2024-04-28