Utilization Management Representative II

Anticipated End Date :

Position Title :

Utilization Management Representative II

Job Description :

Utilization Management Representative II

A proud member of the Elevance Health family of companies Carelon Behavioral Health formerly Beacon Health Options 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.

Location : This role enables associates to work virtually full-time with the exception of 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.

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 an accommodation is granted as required by law.

Hours : Monday through Friday 8 : 30 AM to 5 PM Pacific

The Utilization Management Representative II is responsible for managing incoming calls including triage opening of cases and authorizing sessions.

How you will make an impact :

Managing incoming calls from clients needing mental health and substance use services.

Determines contract and benefit eligibility; provides referral authorization for outpatient services .

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 services.

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.

Minimum Requirements :

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.

Preferred Skills Capabilities and Experiences :

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.

Bachelors degree preferred

Bilingualin Spanish preferred

Experience working in the mental health field preferred

For candidates working in person or virtually in the below locations the salary

• range for this specific position is $19.86 to $31.09

Locations : California

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.

Job Level :

Non-Management Non-Exempt

Workshift : 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.

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. Our values and behaviors are the root of our culture. They are how we achieve our strategy power our business outcomes and drive our shared success - for our consumers our associates our communities and our business.

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.

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 and Influenza. 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. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Required Experience :

Unclear Seniority

Key Skills

Attorney At Law,Customer,Customer Support,Excel,Assembling

Employment Type : Full-Time

Experience : years

Vacancy : 1

Monthly Salary Salary : 19 - 31