Referral Specialist Lead - Elevance Health

Referral Specialist Lead

• Type: Full time
• Job Family: Customer Care
• Date Posted:Jun 23, 2023
• Req #: JR76830

Location:

• National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
• CA, WOODLAND HILLS

Description

A proud member of the preferred. Health family of companies, Carelon Post Acute Solutions, formerly myNEXUS, is the leader in health resource optimization, focused on transforming how healthcare is delivered and promoting the advancement of care for the people we serve.
Training schedule- M-F from 8am-4:30pm CST for two weeks (paid training)
Work schedule- T-Sat from 9am-6pm CST or 10am-7pm CST
The Referral Specialist Lead is responsible for providing technical guidance to Referral Specialist Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for precertification and prior authorization of inpatient and outpatient services.

• Handles escalated and unresolved calls from less experienced team members.
• Handles complex situations and ensures Referral Specialists Reps are directed to the appropriate resources to resolve issues.
• Keeps team members informed of any changes.
• Keeps manager informed of changes or problems.
• Assists management by identifying areas of improvement and recommends solutions.
• Knowledge of health plans, including familiarity with prior authorization and precertification process.
• Knowledge of contracts and strong knowledge of managed benefit programs.
• Keeps departmental manuals up-to-date.
• Motivates and encourages Referral Specialist Reps while providing technical guidance.
• Monitors daily phone activities to exceed NMIS standards and improve customer service levels.
• Understands specific workflow, processes, departmental priorities and guidelines.
• Suggests methods to improve productivity.
• May assists manager with PTO scheduling and monitoring attendance.
• Provides direction and guidance to less experienced team members.

Requirements;

• Requires a minimum of 3+ years of experience in complex customer service or call center environment; or any combination of education and experience which would provide an equivalent background.

Preferences

• Knowledge of medical terminology and plan specific guidelines preferred.
• Excellent customer service and phone etiquette
• Post acute care commercial experience a plus
• Previous leadership experience
• Experience with Utilization Management

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $20.23 - $30.35 per hour
Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY
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, nondiscriminatory 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 considered to be 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.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
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.
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. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 may contact [email protected] for assistance.
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Equal Opportunity Employer / Disability / Veteran
Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

• Privacy Notice for California Residents
• EEO Policy Statement
• Know Your Rights
• Pay Transparency

Elevance Health, Inc. is anE-verify Employer (https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)
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