Get new similar jobs by email for

Utilization Management Represe...


Job Summary

Midland, GA
Other/Not Classified
Job Type
Full Time
Career Level
Experienced (Non-Manager)
Job Reference Code

Utilization Management Representative I - Midland, GA - PS4553

About the Job

Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.
Utilization Management Representative I:

Primary duties may include, but are not limited to:
* Managing incoming authorization call requests
* Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
* Refers cases requiring clinical review to a Nurse reviewer.
* Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
* Responds to telephone inquiries concerning authorizations from providers.
* Conducts clinical screening process.
* Authorizes initial set of sessions to provider.
* Develops and maintains positive customer relations by handling authorization requests promptly and accurately.

* Requires High School diploma or GED
* 1 year of customer service or call-center experience; proficient analytical, written and oral communication skills required.
* Medical terminology training and experience in medical support or insurance field preferred.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers.
EOE. M/F/Disability/Veteran.

Job Tools