Position Title:

Utilization Management Correspondence Representative

Job Description:

Utilization Management Correspondence Representative

Location: Costa Mesa, CA; Walnut Creek, CA; Woodland Hills, CA; Denver, CO; Wallingford, CT; Washington, DC; Wilmington, DE; Miami, FL; Tampa, FL; Atlanta, GA; Midland, GA; West Des Moines, IA; Chicago-Willis Tower, IL; Indianapolis, IN; Louisville, KY; Metairie, LA; Hanover, MD; South Portland, ME; Gilbert, MN; Mendota Heights, MN; St. Louis, MO; Cary, NC; Winston Salem, NC; Lincoln, NE; Manchester, NH; Iselin, NJ; Morristown, NJ; Las Vegas-Maryland, NV; Las Vegas-Russell, NV; Latham, NY; Middletown, NY; New York, NY; Cincinnati, OH; Columbus, OH; Mason, OH; Seven Hills, OH; Smithfield, RI; Nashville, TN; Houston, TX; Grand Prairie, TX; Norfolk, VA; Richmond, VA; Roanoke, VA; Seattle, WA; Waukesha, WI; and/or Charleston, WV

Reasonable proximity (1-hour commute and a 50-Mile radius) to ONE of the listed Elevance Health major offices is required. Elevance Health operates in a Hybrid Workforce Strategy, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. This position will primarily work remotely and requires the ability to participate in on-site meetings as necessary.

Available shifts: Tues – Sat 9-6 CT or 10-7 CT or Sun—Thurs 9-6 CT or 10-7

The Utilization Management Correspondence Representative is responsible for processing and generating letters for services denied by the Utilization Management (UM) Medical Director within established Centers for Medicare and Medicaid Services (CMS) guidelines.

How You Will Make an Impact:

Primary duties may include, but are not limited to:

• Completes denial letters for services denied by Medical Director.
• Generates and prints denial letters for mailing.
• Provides feedback to ensure denials are handled according to CMS standards.
• Collaborates with other departments to produce letters for services denied in their respective units.
• Identifies opportunities to enhance workflow and offers solutions.
• Answers and routes incoming calls from providers, medical groups, and others verifying referral status.

Minimum Requirements:

Requires a HS diploma and a minimum of 2 years of experience in a managed care delivery system and/or Utilization Management; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Knowledge of the UM patient referral process, eligibility, benefits and Health Plan regulations, HMO/UM functions, ICD-9/CPT coding strongly preferred.
• Proficiency with the Microsoft Office suite of products.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $14.80 to $28.04

Locations: California; Colorado; Nevada; New York; Washington State; Jersey City, NJ

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.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Job Level:

Non-Management Non-Exempt

Workshift:

2nd Shift (United States of America)

Job Family:

CUS > Service Operations

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

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. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.