Utilization Management Representative II

Utilization Management Representative II Location: 4751 Hamilton Wolf Rd, Ste 101, San Antonio, TX. Schedule: 8‑hour shift, Monday through Friday, 8:00 am to 6:00 pm (CDT). Additional hours, including weekends or holidays, may be required. Responsibilities Managing incoming calls or incoming post service claims work. Determining contract and benefit eligibility; providing authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests. Obtaining intake (demographic) information from callers. Conducting a thorough radius search in Provider Finder and following up with providers on referrals given. Referring cases requiring clinical review to a nurse reviewer and handling referrals for specialty care. Processing incoming requests and collecting information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization. Verifying benefits and/or eligibility information. Acting as liaison between Medical Management and internal departments. Responding to telephone and written inquiries from clients, providers and in‑house departments. Conducting clinical screening process. Minimum Requirements High school diploma or equivalent. Minimum of 2 years of customer service experience in a healthcare setting and medical terminology training; or any combination of education and experience which provides an equivalent background. Preferred Skills, Capabilities, and Experiences Knowledge of health plans, including familiarity with prior authorization and precertification processes; knowledge of contracts and strong knowledge of managed benefit programs. Previous experience in prior‑authorization management. Prior experience working in a high‑volume environment. Professional Competencies Strong oral, written, and interpersonal communication skills, problem‑solving skills, facilitation skills, and analytical skills. Some contracts may require a Master’s degree. Equal Employment Opportunity Statement Elevance Health is an Equal Employment Opportunity employer. Qualified applicants will receive consideration without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status protected by applicable laws. Applicants who require accommodation to participate in the job application process may contact View email address on click.appcast.io for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws. Prospective employees required to be screened under Florida law should review the education and awareness resources available at HB531 – Florida Agency for Health Care Administration. #J-18808-Ljbffr Elevance Health