utilization management coordinator

Ascension

<div>Your future role at a glance:
<div>
Location: Remote</div><div>
Facility: Ascension and Texas Administrative Office</div><div>
Department: Administrative Support</div><div>
Schedule: Day Shift | Full Time | Monday-Friday</div><div>
Salary: $23.60 - $31.92 (per hour) 
#LI-Remote</div><div>
#LI-AM2</div>
How you'll make an impact in this role:
<ul><li>Organize and coordinate all office support functions, activities, and workflow for the assigned functional area or department.</li><li>
Manage core office services, including supplies, telephone coverage, and the preparation and distribution of correspondence, meeting materials, and reports.</li><li>
Track, disseminate, and maintain current policies and procedures, including making recommendations for improvements to streamline office functions.</li><li>
Organize and maintain filing systems, track scheduling information, and respond to internal and external inquiries, providing information or resources as appropriate.</li><li>
Ensure office operating costs are within budgetary constraints and leverage specialized experience in health plan, healthcare call center, and UM authorization, including data input for nurse review.</li></ul>
What minimum qualifications you'll need:
<div>
Education:</div><ul><li>
High School diploma equivalency OR 1 year of applicable cumulative job specific experience required.<ul><li>
Note: Required professional licensure/certification can be used in lieu of education OR experience, 
if applicable</li></ul></li></ul>
What additional requirements you'll need:
<ul><li>Must have 2 years of Health Plan, Healthcare Call Center, and UM Authorization Experience.</li></ul>
Life at Ascension: Where purpose meets opportunity:
<div>
Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you&rsquo;ll find an inclusive and supportive environment where your contributions truly matter.</div>
Equal employment opportunity employer:

Equal employment opportunity employer
Ascension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws. For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.
Fraud prevention notice
Prospective applicants should be vigilant against fraudulent job offers and interview requests. Scammers may use sophisticated tactics to impersonate Ascension employees. To ensure your safety, please remember: Ascension will never ask for payment or to provide banking or financial information as part of the job application or hiring process. Our legitimate email communications will always come from an @ascension.org email address; do not trust other domains, and an official offer will only be extended to candidates who have completed a job application through our authorized applicant tracking system.
E-Verify statement
<div>Employer participates in the Electronic Employment Verification Program. Please click here for more information.</div> 
<div></div>
Benefits:
<div>
Paid time off (PTO) 
Various health insurance options &amp; wellness plans 
Retirement benefits including employer match plans 
Long-term &amp; short-term disability 
Employee assistance programs (EAP) 
Parental leave &amp; adoption assistance 
Tuition reimbursement 
Ways to give back to your community</div><div></div><div> 
Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance, location and salary range at the time of the offer.</div></div>

Utilization Management Coordinator

Sharp HealthCare

<div>[Other; H.S. Diploma or Equivalent
Hours:
Shift Start Time:
8:30 AM
Shift End Time:
5 PM
AWS Hours Requirement:
8/40 - 8 Hour Shift
Additional Shift Information:
Weekend Requirements:
As Needed
On-Call Required:
No
Hourly Pay Range (Minimum - Midpoint - Maximum):
$28.170 - $35.210 - $39.430 
The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant&rsquo;s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. 
What You Will Do 
This position supports the system centralized utilization management department to meet division and organizational objectives, facilitate effective communication between department staff and the internal and external customers to the department, including but not limited to the business office, revenue cycle, physicians and payers. This position is accountable to ensure timely follow up on payer requests for clinical documentation, optimal inbound and outbound fax management to mitigate denials and ensure established timeliness response metrics are met, and reconciliation of hospital authorizations. Identification and escalation of concerns to the ICM System Centralized Utilization Management team to mitigate denials. Assists in capturing administrative days under the direction of the UM CM's. A key member of the UM customer service team to meet and exceed the customer's expectations.
 
 
Required Qualifications<ul><li>
H.S. Diploma or Equivalent
</li></ul> 
Preferred Qualifications<ul><li>
Other Health related education.
</li><li>Other Successful completion of Medical Assistant Program or equivalent.
</li><li>2 Years hospital experience.
</li><li>2 Years Medi-Cal experience.
</li></ul> 
Essential Functions 
<ul>
<li>Monitor Utilization Management Queues
 
 
Works with the other members of the UM team to monitor timely management of the UM queues. Escalates to management when queues are outside of established turnaround timeframes.
 
Verifies current insurance plan eligibility. Assists the UM CM&rsquo;s to report inaccurate insurance information on the facesheet.
 
Reviews patient list and prioritizes/plans for the day. 
Contributes to the continuous improvement initiatives of the system centralized utilization management team to deliver quality interventions in a timely manner. 
Maintains proactive communications with insurance representatives, UM CM&rsquo;s and TP CM teams at the site level. 
Maintains a current payer contact list to support utilization management activities.
 
Maintains passwords and access to payer portals to ensure timely UM authorization capture.</li>
<li>Teamwork and Collaboration
 
Acts as facilitator between payors and UM team members. 
Ensures UM team members are updated daily and thought out the day as needed. 
Keeps the ICM UM Leadership aware of inability to complete assigned duties or tasks.
 
Responsible for timely and accurate retrieval and appropriate action on departmental phone messages and necessary fax 
communication. 
Work closely with revenue cycle to ensure the latest reimbursement and contract information is available to the utilization managers. 
Work closely with the revenue cycle to make sure all are aware of denials real time. 
Supports staff and leadership to meet department objectives.</li>
<li>Database Management 
Assists with the processing of letters of authorization, appeal or denial. 
Prepare databases and written reports for leads, manager, and director in a timely manner as requested and within the scope of work. 
Initiates and participates in the creation and development of forms and lists. 
Assist UM case managers and physician advisors with denial cases, setting up peer to peer reviews as needed. 
Must demonstrate attention to detail and accuracy.</li>
<li>Department Operations 
Ensures UM staff have appropriate resources and information to expedite smooth transition to through continuum
 
and optimize third party payer reimbursement. 
Monitor authorization for all patients in-house to ensure reimbursement and payment for correct level of care. 
Monitor completion of retro reviews and notifies lead of reviews pending by noon the second business day of the request. 
Provide needed documentation for Medi-Cal TAR free process, and complete TARs timely for those patients who are not 
appropriate for the TAR free process. 
Attends department meetings. 
Initiates and participates in huddles and quality improvement activities. 
All work is consistently completed on time and in a timely manner.</li>
<li>Authorization Reconciliation
 
Confirm discharges from previous day and ensure that authorizations or denials are captured and documented. 
Documents activities as per the departmental processes and with the electronic medical record.</li>
<li>Industry Skills and Competency 
Obtain detailed benefit coverage for complex requests specific to patient plan coverage. 
Investigate and follow-up on all eligibility issues in accordance with hospital guidelines. 
Performs review of all prior authorizations, entering into the electronic medical record. 
Researches and assists in the denial process-gathers documentation for the UR lead, director, and attending physician.</li>
<li>SCMG UMRC Specific 
Obtain detailed benefit coverage for the more complex requests for service specific to member plan coverage.
 
Apply the principles of SCMG guidelines and Health Plan benefit guidelines to approve referrals designated at the CRC level.
 
Investigate and follow-up on all eligibility issues in accordance with health plan and SCMG guidelines.
 
Process referrals for prior authorization.
 
Coordinate, review and process the more complex referrals for prior authorization for medical care and services, including emergency room, inpatient admission, durable medical equipment, home care and other miscellaneous services for the efficient and effective delivery of inpatient services. 
Performs review of all prior authorization referrals. (Responsible for all levels of the referral from generation, approval and acquisition). 
Obtains necessary medical information for use by themselves, Medical Directors, the Hospitalist Physician and/or Case Manager. 
Identifies and refer requests for review by higher level staff (Medical Director, Hospitalist or HCM) within department turn around time (TAT) standards. 
Research and assist in the denial process - gathers documentation after review by medical director, ensure packet information is complete, assesses and select the appropriate denial reason. Maintain mandated TAT for denials. 
Obtains and gathers clinical information from multiple sources including use of Sharp and/or Hospital applications to retrieve patient medical records for review by Hospitalist Case Managers, SNF's or outpatient service providers. 
Verifies and documents eligibility and benefit details. 
Obtains prior authorizations for specific medications, through SCMG Pharmacy or through the patient's health plan when applicable. Has all information available to help with the review process. 
Informs and distributes health plan criteria to the Medical Director, CM or themselves to make a determination regarding an authorization for service or equipment. 
Updates inpatient IDX referrals with correct diagnoses, bed type and disposition. 
Generates or assist in the dissemination of Case Management Referrals. 
Generate informational referrals for patients that are accepted to hospice while admitted as inpatient. 
Research and interpret all ICD-10, CPT and HCPC coding using appropriate tools. 
Make determination on the more complex claims that are designated CC authorization level within SCMG TAT guidelines. 
Coordinates, reviews and processes more complex retrospective claims for medical care and services, including, SNF inpatient admission, medical transportation, durable medical equipment and other miscellaneous services for the efficient and effective facilitation of claim adjudication. 
Tracks and informs identified personnel of expired patients.</li>
<li>Professional Development 
Actively identifies gaps in skills and competencies and participated in seminars/classes to enhance gaps. 
Attends and actively participates in department/team process/quality improvement activities. 
Actively participates in all-staff meetings and stand-ups.</li>
</ul>
 
Knowledge, Skills, and Abilities<ul><li>
Bilingual preferred.</li>
<li>Knowledge of hospital payors preferred.</li>
<li>General filing knowledge.</li>
<li>Demonstrated proficiency in Microsoft Word, Microsoft Excel, Microsoft Outlook, and other software programs.Excellent organization, managerial and time management skills with the ability to multi-task.</li>
<li>Excellent analytical, problem solving and supervisory skills, knowledgeable of medical terminology, and current standards of clinical practice, professional counseling, mentorship and resource allocation.</li>
<li>Knowledgeable in the use of ICD-10, CPT4, and HCPC coding systems.</li>
<li>Proficient in typing and computer data entry (45 wpm).</li>
<li>Excellent verbal and written communication skills.</li>
<li>Ability to read, speak, and hear English clearly.</li>
<li>Able to work independently in research and decision making with minimal direction from higher level of staff.</li></ul> 
Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class</div>

Utilization Management Resource Coordinator - Sharp Spectrum Corporate Offices - Full-Time - Day Shift

Cottage Health

<div>The Access Case Manager is responsible for utilization review, utilization management, and quality assurance activities for assigned ares of responsibility within the Cottage Health System. Additionally, the case manager will champion, engage, manage and monitor proactive communications and interventions by and between relevant stakeholders with regard to care management. Case management will work collaboratively and proactively with the medical staff, nursing staff and other disciplines to support and achieve the goals of the collaborative care process. Case managers will maintain a working knowledge of regulations and provider contracts governing coverage of inpatient services (i.e., Medicare, Medi-Cal, California Children Services, Genetically Handicapped People Program, Contracted Medical Groups). They will maintain and model interpersonal skills and productive relationships that allow for and support effective interaction with a wide variety of stakeholders. Case managers will consistently demonstrate professionalism and compassion with regard to human dignity, preserving and protecting client autonomy and rights and with respect for patient/family values and beliefs. Case management activities will result in quality outcomes, optimal care/cost management of services and/or procedures, a high level of customer satisfaction, and contribution to an overall value-oriented experience of stakeholders and persons served.</div>

Access Case Manager

Vivant Health

<div>Job Summary:
The Emergency Room (ER) Intake Coordinator coordinates and supports activities related to case management and ED utilization. Performs research to include member demographics, health and history, ECM/CCM enrollment, approved authorizations, and creates cases for outreach. Provides clerical assistance and prepares reports for the Manager of Case Management.
Responsibilities:<ul><li>
Answers telephone in a prompt, professional, courteous and helpful manner; screens and directs calls to appropriate staff members or departments.
</li><li>Effectively work with providers, nurses, case managers, UM/QM Manager(s), and Medical Directors and/or any other colleague/customer/patient.
</li><li>Receives and enters appropriate information from referrals.
</li><li>Assists with examination of records, related documents, corresponds with providers and health plan personnel to obtain facts regarding members.
</li><li>Verifies member eligibility by systems inquiry or health plan contact.
</li><li>Requests clinical records per procedure.
</li><li>Accurately applies appropriate policies, procedures, and eligibility and benefit policies.
</li><li>Maintains current knowledge of provider network as it continues to develop and change.
</li><li>Prepares, communicates and monitors effective follow up plans for patients which may include coordination/input from multiple departments and utilizing information gathered during research.
</li><li>Effectively manages projects and objectives in a timely manner.
</li><li>Develops positive and professional working relationships with providers, nurses, case managers, and Medical Directors to ensure system inputs of electronic and manual referrals are processed, timely, accurately and within production standards.
</li><li>Adheres to company policies, procedures, guidelines and directives. Recognizes and enforces company security measures, maintains strict confidentiality and complies with HIPPA standards.
</li><li>Enhances professional growth and development through in-service meetings and educational programs.
</li><li>Assist department in identifying opportunities for workflow improvements.
</li><li>Contributes to a healthy, positive and safe environment while promoting self as a team member.
</li><li>Maintains strict confidentiality.
</li><li>Performs related duties consistent with the scope and intent of the position.</li><li>
Regular attendance.</li><li>
Travel as required.</li></ul>
Other Functions<ul><li>
Enforces Company policies and safety procedures.</li><li>
Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.</li><li>
Maintain IPA, Health Plan compliance standards.</li></ul>
Competencies<ul><li>
Two (2) + years of utilization management coordination experience is required.
</li><li>Three (3) + years&rsquo; experience in the medical field is required.
</li><li>Ability to type a minimum of 45 WPM.
</li><li>Ability to professionally and efficiently manage intake activities.
</li><li>Ability to multi-task, solve problems and analyze data in a fast-paced environment.
</li><li>Ability to intervene and diffuse difficult calls.
</li><li>Demonstrates a comprehensive knowledge of Health Plan Benefits, DOFR, EMR, and the various departmental functions.
</li><li>Demonstrated ability to assess, evaluate and interpret medical information.
</li><li>Proficiency with computer and standard business software (MS Office applications) and ability to learn in-house and other systems quickly with minimal training.
</li><li>Strong oral and written communication skills, with the ability to communicate professionally with diverse individuals and groups internal and external to Vivant.
</li><li>Ability to consistently deliver excellent customer service.</li><li>
Ability to solve mid-level problems with minimal supervision.</li><li>
Excellent active listening and critical thinking skills.
</li><li>Ability to multi-task, exercise excellent time management, and meet multiple deadlines.
</li><li>Ability to provide and receive constructive job and/or industry related feedback.
</li><li>Ability to maintain confidentiality and appropriately share information on a need-to-know basis.
</li><li>Ability to exercise sound discretion and strict maintenance of confidentiality of all confidential and sensitive communications and information.
</li><li>Excellent attention to detail and ability to document information accurately.
</li><li>Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives.
</li><li>Must have high-level skills in Microsoft software (Word, Excel, Outlook).
</li><li>Must have the ability to quickly learn and use new software tools.
</li><li>Must have mid-level skills using e-mail applications.
</li><li>Self-motivated with strong organizational, multi-tasking, planning, and follow up skills.
</li><li>Ability to work independently as well as in a team environment.
</li><li>Demonstrate commitment to the organization&rsquo;s mission.
</li><li>Ability to present self in a professional manner and represent the Company image.
</li></ul>Education and Licensure<ul><li>
High School Diploma or GED minimum.
</li><li>Minimum of two years advanced education from an accredited educational institution preferred.
</li><li>Medical Assistant Certification preferred.
</li></ul>Travel<ul><li>
The incumbent may travel up to 5% of the time.</li></ul>
Supervisor Responsibility<ul><li>
This position does not have any supervisor responsibilities.</li></ul>
Work Environment
This job operates in a professional office environment. This role routinely uses office equipment such as computers, phones, photocopiers, scanners and filing cabinets.</div>

EMERGENCY ROOM INTAKE COORDINATOR

Cigna Healthcare

<div>
 
 
 The Medical Review Technician is responsible for coordinating and collaborating in the medical review process. This role requires providing courteous and prompt preparation and responses for all referrals.
 
 
 
 
 
 
 Professional communication with peers, supervisors, subordinates, vendors, customers, and the public is essential, along with maintaining a respectful and courteous demeanor in all interactions.
 
 
 
 
 
 Essential Job Functions
 
 
 
 <ul>
 <li>
 Manages daily work assignments.
 </li>
 <li>
 Understands general medical terminology.
 </li>
 <li>
 Assists in managing incoming faxes.
 </li>
 <li>
 Coordinates the receipt and entry of pretreatments and/or pre-certification requests.
 </li>
 <li>
 Ensures accurate coding using CPT and ICD codes
 </li>
 <li>
 Communicates with attending/servicing providers to obtain complete and accurate information.
 </li>
 <li>
 Uploads and monitors external reviews sent to external review companies.
 </li>
 <li>
 Corresponds with external review companies as necessary.
 </li>
 <li>
 Preforms quality controls on review responses for accuracy and completeness.
 </li>
 <li>
 Accurately processes review determinations in required timeframes.
 </li>
 <li>
 Coordinates with clinical team as necessary.
 </li>
 <li>
 Documents in Care Management Platform with accuracy and timeliness.
 </li>
 <li>
 Facilitates and schedules Peer-to-peer requests.
 </li>
 <li>
 Reviews accuracy of member account in Care Management platform and reports as necessary.
 </li>
 <li>
 Initiates referrals for Case Management when appropriate.
 </li>
 <li>
 Participates in team meetings, committees, or committee assignments.
 </li>
 <li>
 Receives and relays communications to the appropriate parties in a timely manner.
 </li>
 <li>
 Contributes to the daily workflow with regular and punctual attendance.
 
 
 </li>
 </ul>
 
 Requirements
 
 
 
 Minimum Education: High school graduation or GED required.
 
 
 Minimum Experience: Medical terminology and medical coding experience preferred.
 
 
 
 Other Qualifications
 
 
 
 <ul>
 <li>
 Excellent oral and written communication skills required.
 </li>
 <li>
 PC skills, including Windows and Word. Ability to learn all functions of the claims processing software as is necessary for claims processing and adjudication. Must be able to adapt to software changes as they occur.
 </li>
 <li>
 Knowledge of medical terminology and basic health insurance concepts.
 </li>
 <li>
 Excellent listening skills.
 </li>
 <li>
 High level of interpersonal skills to work effectively with others.
 </li>
 <li>
 Ability to organize and recall large amounts of detailed information
 </li>
 <li>
 Ability to read, analyze and interpret benefit summary plan descriptions, insurance documents, plan benefits, and regulations and make appropriate applications to specific situations.
 </li>
 <li>
 Ability to identify errors/oversights and make corrections.
 </li>
 <li>
 Ability to project a professional image and positive attitude in any work environment
 </li>
 <li>
 Ability to comply with privacy and confidentiality standards.
 </li>
 <li>
 Ability to be flexible, work under pressure and meet deadlines.
 </li>
 <li>
 Ability to analyze and solve problems with professionalism and patience, and to exercise good judgment when making decisions.
 </li>
 <li>
 Ability to operate typical office equipment.
 </li>
 <li>
 Working knowledge of general office procedures.
 </li>
 <li>
 Ability to meet standard deadlines and timelines for appeals and reviews.
 </li>
 <li>
 Basic mathematical skills.
 
 
 </li>
 </ul>
 
 About Allegiance By Cigna Healthcare
 
 
 
 Since 1981, Allegiance by Cigna Healthcare has specialized in administering medical benefits, including claims processing, customer service, utilization management, and case management. With a high-touch approach to member and client service, Allegiance supports some of the nation&rsquo;s most innovative health benefit strategies.
 
 
 Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. &copy; 2026 Cigna Healthcare
 
 
 If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
 
 
 
 About Cigna Healthcare
 
 
 
 Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
 
 
 
 Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
 
 
 
 
 If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
 
 
 
 
 The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
 
 
 
 
 Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
 
</div>

Medical Review Technician - Cigna Healthcare - Remote

Elevance Health

<div>Job ID:JP00046432
Anticipated Start Date: 05/13/2026
Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.
Elevance Health is a health company dedicated to improving lives and communities &ndash; 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.
Responsible for coordinating cases for precertification and prior authorization review.
Primary duties may include, but are not limited to:<ul><li>
Managing incoming calls or incoming post services claims work.
</li><li>Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.</li><li>
Refers cases requiring clinical review to a Nurse reviewer.
</li><li>Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.</li><li>
Responds to telephone and written inquiries from clients, providers and in-house departments.
</li><li>Conducts clinical screening process.
</li><li>Authorizes initial set of sessions to provider.
</li><li>Checks benefits for facility based treatment.
</li><li>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.</li></ul>
Requirements:<ul><li>
Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
</li><li>Associates will need to review service details and enter the authorization in our system and electronically send a confirmation letter to the provider. Associates will need to review our fax queues and pend a line in our UM system.</li><li>
Medical terminology training and experience in medical or insurance field preferred.
</li><li>Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.</li></ul>
Job Type: Contract Opportunity only
Additional Details:<ul><li>
100% remote.
</li><li>Monday - Friday 8 AM-5 PM EST. - NO OVERTIME / NO WEEKEND</li></ul> 
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. 
About BCForward:
Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally. 
BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work. 
BCForward is 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 based on disability. 
To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process. 
This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.
<div>Pay Rate Range
13.12 - 23.8 USD hourly
</div><div>Additional Notes
The pay range is the range BCForward 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.
</div><div>Benefits Information
BCForward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.
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. This does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).</div></div>

Utilization Management Rep I (contract)

<div>Job ID:JP00046432
Anticipated Start Date: 05/13/2026
Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.
Elevance Health is a health company dedicated to improving lives and communities &ndash; 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.
Responsible for coordinating cases for precertification and prior authorization review.
Primary duties may include, but are not limited to:<ul><li>
Managing incoming calls or incoming post services claims work.
</li><li>Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.</li><li>
Refers cases requiring clinical review to a Nurse reviewer.
</li><li>Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.</li><li>
Responds to telephone and written inquiries from clients, providers and in-house departments.
</li><li>Conducts clinical screening process.
</li><li>Authorizes initial set of sessions to provider.
</li><li>Checks benefits for facility based treatment.
</li><li>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.</li></ul>
Requirements:<ul><li>
Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
</li><li>Associates will need to review service details and enter the authorization in our system and electronically send a confirmation letter to the provider. Associates will need to review our fax queues and pend a line in our UM system.</li><li>
Medical terminology training and experience in medical or insurance field preferred.
</li><li>Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.</li></ul>
Job Type: Contract Opportunity only
Additional Details:<ul><li>
100% remote.
</li><li>Monday - Friday 8 AM-5 PM EST. - NO OVERTIME / NO WEEKEND</li></ul>
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
About BCForward:
Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.
BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.
BCForward is 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 based on disability.
To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.
This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration. employed
<div>Benefits Information
BCForward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.
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. This does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).</div></div>

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