Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and 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.

This is an exceptional opportunity to do innovative work as a contractor at Anthem (via BC Forward) that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

The Utilization Management Rep II for managing incoming calls, including triage, opening of cases and authorizing sessions.

Primary duties may includes, but are not limited:

• Manage 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.
• Obtains intake (demographic) information from caller.
• Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given.
• Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care.
• Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization.
• Verifies benefits and/or eligibility information.
• May act as liaison between Medical Management and internal departments.
• Responds to telephone and written inquiries from clients, providers and in-house departments.
• Conducts clinical screening process.
• Refers cases requiring clinical review to a Nurse reviewer.

Requirements:

Requires HS diploma or equivalent; 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience, which would provide an equivalent background.

Preferred Experience & Candidate Characteristics:

• Crisis line or mental healthcare experience very strongly preferred
• Experience working on a text/chat platform completing assessments preferred
• Master’s Degree
• De-escalation skills
• Motivational interviewing or similar skills
• Strong oral, written and interpersonal communication skills
• Problem-solving skills

Work Schedule:

Must be able to work a flexible schedule (TBD)

• This role supports a 24/7/365 call center environment. This role is responsible for assessing individuals who are in crisis, provide in the moment support, and apply an appropriate intervention that meets the needs of the member as well as ensure the utmost safety. This position will be 100% remote and will be heavily based in technology including but not limited to, computer, web applications, and text/chat software

An Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.