Licensed Utilization Review II (US) ID-9608

February 1, 2025

Elevance Health is seeking a dedicated Licensed Utilization Review II professional to collaborate with healthcare providers, ensuring the appropriate administration of plan benefits. This role involves collecting clinical information for service preauthorization, assessing medical necessity, and applying relevant medical policies and clinical guidelines.

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Responsibilities:

Conduct pre-certification, inpatient, retrospective, out-of-network, and appropriateness of treatment setting reviews within the scope of licensure.
Develop relationships with physicians, healthcare service providers, and internal and external customers to improve health outcomes for members.
Apply clinical knowledge to work with facilities and providers for care coordination.
Consult with peer clinical reviewers, Medical Directors, and/or delegated clinical reviewers to ensure medically appropriate, quality, cost-effective care.
Educate members about plan benefits and contracted healthcare providers.
Refer treatment plans to peer clinical reviewers according to established criteria and guidelines.
Facilitate accreditation by applying accrediting and regulatory requirements and standards accurately.
May lead cross-functional teams, projects, initiatives, and process improvement activities.
May serve as a departmental liaison to other areas of the business unit or as a representative on enterprise initiatives.

Requirements:

High school diploma or equivalent.
Minimum of 2 years of clinical or utilization review experience and a minimum of 3 years of managed care experience; or any combination of education and experience that provides an equivalent background.
Current active unrestricted license or certification as an LPN, LVN, or RN to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States.

Preferred Qualifications:

Bachelor's degree in nursing.
Current active unrestricted license or certification as an RN in the state of Florida.
Minimum of 2 years of Long-Term Care clinical or Long-Term Care utilization review experience and a minimum of 3 years of managed care experience.
Previous Medical Review and/or Prior Authorization/Pre-Certification experience.
Certification in the American Association of Managed Care Nurses.
Knowledge of the medical management processes and the ability to interpret and apply member contracts, member benefits, and managed care products.
Proficiency in Microsoft Office.

Benefits:

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

Why Join Us?

At Elevance Health, we are committed to improving health outcomes and making a positive impact on the communities we serve. As a Licensed Utilization Review II, you will play a crucial role in ensuring our members receive appropriate and effective care. We offer a collaborative work environment, opportunities for professional growth, and a comprehensive benefits package to support your well-being.

How to Apply:

If you are passionate about making a difference in healthcare and meet the qualifications outlined above, we encourage you to apply for the Licensed Utilization Review II position at Elevance Health. Please submit your application through our careers portal: Elevance Health Careers.

Licensed Utilization Review II (US) ID-9608

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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Other Jobs You May Be Interested In

Licensed Utilization Review II (US) ID-9608

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

5. HOW DO YOU PROCESS INFORMATION?

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

8. HOW TO PRIORITIZE WORK?

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

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