Licensed Utilization Review II (US)

About the position

The Licensed Utilization Review II position at Elevance Health is primarily focused on collaborating with healthcare providers to ensure the appropriate administration of plan benefits. This role involves collecting clinical information for preauthorization of services, assessing medical necessity, and applying clinical guidelines and medical policies within the scope of licensure. The position requires handling complex benefit plans and may involve mentoring less experienced staff.

Responsibilities
? Conduct pre-certification, inpatient, retrospective, out of network, and appropriateness of treatment setting reviews within scope of licensure.
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? Develop relationships with physicians, healthcare service providers, and internal and external customers to improve health outcomes for members.
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? Apply clinical knowledge to work with facilities and providers for care-coordination.
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? Educate members about plan benefits and contracted healthcare providers.
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? Facilitate accreditation by applying accrediting and regulatory requirements and standards.

Requirements
? High School diploma or equivalent required.
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? Minimum of 2 years of clinical or utilization review experience.
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? Minimum of 1 year of managed care experience.
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? Current active unrestricted license or certification as a LPN, LVN, or RN from the state of residence.

Nice-to-haves
? Utilization Management experience is strongly preferred.
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? Previous UM experience working with the Medicaid population is preferred.
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? Strong oral, written, and interpersonal communication skills.
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? Problem-solving, facilitation, and analytical skills.

Benefits
? Merit increases
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? Paid holidays
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? Paid Time Off
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? Incentive bonus programs
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? Medical, dental, and vision benefits
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? Short and long term disability benefits
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? 401(k) with matching
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? Stock purchase plan
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? Life insurance
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? Wellness programs
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? Financial education resources

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