Utilization Management Representative I - Midland, GA - PS1401
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Anthem, Inc. is the nation's leading health benefits company serving the needs of approximately 40 million medical members nationwide.
Utilization Management Rep 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
• Medical terminology training and experience in medical support or insurance field required.
• Coding experience preferred
• CNA, CMA 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.
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