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Anthem, Inc. Utilization Management Representative III in Harrisburg, Pennsylvania

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Beacon Health Options, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.

For more than 30 years, Beacon Health Options has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 37 million people across all 50 states. At Beacon, our mission is to help people live their lives to the fullest potential. Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

The Utilization Management Representative III is responsible for coordinating cases for precertification and prior authorization review. This level is expected to be able to perform all of the duties of the Utilization Management Rep II in addition to the following primary duties.

Responsibilities:

  • Responsible for providing technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services outside of initial authorized set.

  • Assisting management by identifying areas of improvement and expressing a willingness to take on new projects as assigned.

  • Handling escalated and unresolved calls from less experienced team members; ensuring UM Reps are directed to the appropriate resources to resolve issues.

  • Ability to understand and explain specific workflow, processes, departmental priorities and guidelines.

  • May assist in new hire training to act as eventual proxy for Ops Expert.

  • Exemplifies behaviors embodied in the 5 Core Values.

Qualifications

Qualifications:

  • Requires a high school diploma/GED from an accredited Institution.

  • 3 years of experience in customer service experience in behavioral healthcare related setting; or any combination of education and experience, which would provide an equivalent background.

  • Medical terminology training required.

  • Must be able to work remote on a permanent basis.

  • For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Certain contracts require a Master's degree.

  • Flexible and quick learner, willing to adapt to changing customer and business needs.

  • Ability to work from home with internet access and a quiet and private workspace.

  • Ability to work from 9:30am - 6:00pm EST Sunday -Thursday or Tuesday - Saturday.

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. Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

REQNUMBER: PS45298-Pennsylvania

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