Utilization Management Rep I

We need to output HTML fragment with sections: headings

for sections like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections if posting has real specific content. Must not repeat job title as heading. Must not include Job ID etc. Must preserve all substantive info, remove boilerplate (cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, application instructions). Also must not include filler like "commensurate with experience". Must not create Pay/Schedule/Benefits sections unless posting actually states them. We need to parse the posting. Key content: - Utilization Management Representative I Shift: Monday-Friday Location: Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. - The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. - How You Will Make An Impact Managing incoming calls or incoming post services claims work. 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 and written inquiries from clients, providers and in-house departments. Conducts clinical screening process. Authorizes initial set of sessions to provider. Checks benefits for facility based treatment. Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner. Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers. Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment. Strong verbal and written communication skills, both with virtual and in-person interactions. Attentive to details, critical thinker, and a problem-solver. Demonstrates empathy and persistence to resolve caller issues completely. Comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts. Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary. Performs other duties as assigned. - Minimum Qualifications HS diploma or GED. Minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background. - Preferred Skills, Capabilities And Experiences Medical terminology training and experience in medical or insurance field preferred. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. - For candidates working in person or virtually in the below locations, the salary* range for this specific position is $16.86 to $21.00 Location: Virginia and New York - 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 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. #EHS Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. - Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. - How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. 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. Unless 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. 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 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration. We need to remove boilerplate: cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. The "Who We Are", "How We Work", EEO statements, vaccination requirement, etc. Are those considered boilerplate? The instruction says remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. So we should remove sections that are purely legal/EEO etc. The "Who We Are" and "How We Work" might be considered company overview, not strictly legal boilerplate. But they might be considered generic fluff. However they contain substantive info about company culture, benefits, etc. The instruction says "Prefer a few substantive sections over many thin ones." We need to include sections only when posting has real specific content. The "Who We Are" and "How We Work" are generic but could be considered substantive? They are not specific to the role. Might be considered boilerplate. The instruction says remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate. It doesn't explicitly say remove company overview. However "Who We Are" and "How We Work" are typical boilerplate but could be considered fluff. The instruction: "Prefer a few substantive sections over many thin ones." So we might include only sections that have role-specific content: About the role (maybe we can incorporate the description), Responsibilities, Requirements/Qualifications, Skills, Benefits, Pay, Schedule. We need to decide which sections have actual content. Let's extract role-specific content: - About the role: The first paragraph about virtual work, shift Monday-Friday, location virtual, training, etc. That's role-specific. - Responsibilities: The bullet list of duties: managing calls, determining eligibility, authorizations, referring to nurse reviewer, data entry, responding to inquiries, clinical screening, authorizing sessions, checking benefits, maintaining relations, multi-task, focus, communication skills, detail-oriented, empathy, digital tools, structured schedule with occasional overtime, ability to work from office as needed, other duties. - Requirements/Qualifications: Minimum Qualifications: HS diploma or GED, 1 year customer service or call-center experience or equivalent. - Preferred Skills: Medical terminology training/experience preferred; for URAC areas: strong oral/written/interpersonal communication, problem-solving, facilitation, analytical skills. - Benefits: "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)." Also earlier: "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." That's generic but still benefits. However we need to avoid boilerplate. The benefits description is somewhat generic but still specific to Elevance Health. Might be okay. - Pay: Salary range $16.86 to $21.00 for Virginia and New York. Also note that salary based on factors etc. That's pay info. - Schedule: "Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary." Also shift Monday-Friday. So schedule info. We need to output HTML with

headings for each section we include. Use

• for any list of duties/requirements/benefits. Use

  for prose. We must not repeat job title as heading. So no

  Utilization Management Representative I

  . Use headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Possibly combine Requirements and Qualifications into one section? The instruction says use headings for those categories if they exist. We can have separate sections for Requirements and Qualifications if content distinct. But we have minimum qualifications (requirements) and preferred skills (capabilities). Could treat Requirements as minimum qualifications, Qualifications as preferred? Or combine. Let's decide: We'll have sections: About the role, Responsibilities, Requirements (minimum qualifications), Preferred Skills, Benefits, Pay, Schedule. We must not include sections with filler like "commensurate with experience". Not present. We must not include duplicated lines. Ensure we don't repeat same info. Now craft content. About the role: combine first paragraph about virtual work, shift Monday-Friday, location virtual, training, etc. Also