Utilization Management Representative I - Midland, GA - PS1401

Company: Anthem, Inc. ( Learn More )

General Information
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Job Description 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.  

Job Requirements•    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. 
EOE. M/F/Disability/Veteran.