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Utilization Management Representative I - Midland, GA - PS1401 at Anthem, Inc.

Posted in Admin - Clerical 30+ days ago.

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Type: Full-Time
Location: Midland, Georgia

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.  

•    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.