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Utilization Management Representative I/II- MO, WI, KY, IN, OH- PS26706Location: Missouri, United StatesNewRequisition #: PS26706Utilization Management Representative I/IIWellPoint is one of the nation's leading health benefits companies and a Fortune Top 50 company. At WellPoint, we are dedicated to improving the lives of the people we serve and the health of our communities. WellPoint strives to simplify the connection between health, care, and value for our customers.Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and theopportunity to take your career further than you can imagine.Utilization Management Representative I/II:
Responsible for coordinating cases for precertification and prior authorization review.
Primary duties may include, but are not limited:
Managing incoming calls or incoming post services claims work.
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 and written inquiries from clients, providers and in-house departments.
Conducts clinical screening process.
Authorizes initial set of sessions to provider.
Checks benefits for facility based treatment.
Develops and maintains positive customer relations and coordinates with various functions within the company to
ensure customer requests and questions are handled appropriately and in a timely manner.
Requires High school diploma;
Customer service expereince required.
proficient analytical, written and oral communication skills;
or any combination of education and experience, which would provide an equivalent background.
Medical terminology training and experience in medical or insurance field preferred.
Call center experience preferred.
WellPoint is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, andis a 2012 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us atwww.wellpoint.com/careers. EOE
