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Added 7 mins ago
C
Call Center Operations Manager
Cognizant
Mesa, AZ
- $90,000 to $109,000 USD / year
…level. The Operations Manager works closely with Team Leads and Workflow Leads to ensure operational program success by identifying and tracking contractual SLA and KPI performance, setting…
Added 54 mins ago
Integration & Business Acceleration Associate
Indeed
Jackson, MS
Experience with AI tools, agents, and workflow automation, along with configuring project management tools to manage multiple workstreams.
Added 2 hours ago
Project Construction Superintendent - Building Group
Kiewit
Lincoln, NE · Omaha, NE
A Superintendent at Kiewit is a leadership role responsible for overseeing all aspects of a project's execution, including planning, resource allocation, and ensuring successful completion.…
Added 2 hours ago
Systems Engineering, Integration, and Test (SEIT) Lead
BAE Systems
Hudson, NH
Project/Program team member responsible for workflow, which is dynamic in nature.
Added 5 hours ago
Manufacturing Engineering Co-op (Summer/Fall 2027)
Collins Aerospace
Louisville, KY
Develops and implements digital solutions, such as dashboards, automated reports, and workflow tools, that replace manual processes and improve real-time visibility
Added 6 hours ago
Corporate Project Engineer
BWAY
Cincinnati, OH
JOB DESCRIPTION The Project Engineer is responsible for identifying, developing, and executing continuous improvement and operational excellence initiatives across NASP Metals facilities.…
Added 7 hours ago
Assistant Project Manager
Landry French Construction Co
St. Petersburg, FL · Melbourne, FL
Assist in the development and maintenance of project schedules utilizing Critical Path Method (CPM) scheduling techniques.
Added 9 hours ago
Medical Laboratory Assistant II - Anatomic Pathology
Houston Methodist
The Woodlands, TX
…job, especially with regard to activities impacting patient or employee safety or…
Added 9 hours ago
Lead Mammography Technologist
Houston Methodist
The Woodlands, TX
…develop staff; and provide feedback on staff performance or development needs. The Lead Mammography Technologist position may direct or regularly participate in special projects; collect,…
Added 9 hours ago
C
Call Center Operations Manager
Cognizant
Plano, TX
- $90,000 to $109,000 USD / year
…level. The Operations Manager works closely with Team Leads and Workflow Leads to ensure operational program success by identifying and tracking contractual SLA and KPI performance, setting…
Added 9 hours ago
Pharmacy Manager - San Antonio, TX, Amazon Pharmacy
Amazon
San Antonio, TX
customer experience, budgetary, people development and operations objectives. The Pharmacy
Added 9 hours ago
Business Banking Service Delivery Manager, Vice President
Citigroup
San Antonio, TX
Team Structuring & Development: Critically evaluate existing team structures and directly implement strategic adjustments to optimize resource allocation, workflow, and responsiveness.…
Added 9 hours ago
Base Fabrication & Paint Manager
Panelmatic Inc.
Houston, TX
…team leads while coordinating labor, materials, equipment, workflow, and production priorities. This role will ensure fabricated steel structures and components are completed according to…
Added 9 hours ago
I&E Designer
Actalent
Houston, TX
…with multiple disciplines to deliver high-quality, on-schedule project deliverables. The role requires deep technical expertise in industrial electrical systems, strong CAD and design…
Added 9 hours ago
DPS - DLD - DLD Supervisor - 1584
TEXAS DEPARTMENT OF PUBLIC SAFETY DEPT 405
Houston, TX
Added 9 hours ago
DPS - DLD - DL Supervisor, Field Ops - 1584
TEXAS DEPARTMENT OF PUBLIC SAFETY DEPT 405
HOUSTON, TX
Added 9 hours ago
Manager - Clinical Protocol Admin / Nuclear Medicine
MD Anderson Cancer Center
Houston, TX
Manage resource planning and operational workflow development
Added 11 hours ago
Regional Support Floater Pharmacist
CenterWell
Miami, FL · Hialeah, FL · Pembroke Pines, FL · North Miami Beach, FL · Plantation, FL · Deerfield Beach, FL
…complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercise considerable latitude in determining goals and approaches to…
Added 11 hours ago
PN
Research Engineer III - Building Energy Modeling
Pacific Northwest National Laboratory
Portland, OR · Richland, WA · Seattle, WA
- $112,500 USD / year
The successful candidate will be accountable to Project and/or Task Managers for performing assigned roles, following applicable project and field procedures, and completing assigned tasks…
Added 11 hours ago
PN
Research Engineer II - Building Energy Modeling
Pacific Northwest National Laboratory
Portland, OR · Richland, WA · Seattle, WA
- $89,300 USD / year
The successful candidate will be accountable to Project and/or Task Managers for performing assigned roles, following applicable project and field procedures, and completing assigned tasks…
Added 11 hours ago
M365 / Power Platform Developer
Dev Technology Group, Inc.
Egg Harbor City, NJ
Key Responsibilities Power Platform Development Design, develop, test, deploy, and maintain applications using Microsoft Power Platform. Build Power Apps Canvas and Model-Driven…
Added 11 hours ago
G
Data Governance & Data Catalog Lead
Guidehouse
WASHINGTON, DC
- $113,000 to $188,000 USD / year
Establish AI governance and responsible AI guardrails such as model and use case inventory, risk management workflow, review boards, documentation standards, third-party oversight, and…
Added 11 hours ago
G
Data Governance & Data Catalog Lead
Guidehouse
WASHINGTON, DC
- $130,000 to $216,000 USD / year
Establish AI governance and responsible AI guardrails such as model and use case inventory, risk management workflow, review boards, documentation standards, third-party oversight, and…
Added 11 hours ago
Program Analyst
Veterans Benefits Administration
Washington, DC
…qualitative & quantitative data collection and analysis, & project management duties. Responsibilities Specific duties include: Develops, revises, and implements VR&E business processes and…
Added 12 hours ago
Senior Project Controls Administrator
Buckeye Partners, L.P.
Allentown, PA
…decarbonization efforts on our operations. Role Summary: The Senior Project Controls Administrator (PCA) is responsible for providing support to projects as well as creating and updating…

Excellus BlueCross BlueShield

Utilization Management Services Representative I (Multiple Openings!)

Rochester, NY, United States

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Job details

Posting language: English
Posted: Oct 30, 2026

Original job description

Job Description:

Summary:

This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both internal and external customers through completing timely and accurate inbound and/or outbound calls, creating authorizations via phone, Care Advance Provider Tool, and fax for inpatient and outpatient procedures, behavioral health, and durable medical equipment.

Essential Accountabilities:

Level I

Facilitates inbound and outbound calls to customers (members and providers) by delivering excellent customer-centered service providing information regarding services in a call center environment.
Responds to customers in a professional, efficient manner to encourage public acceptance of products, services, and policies.
Perform triage for UM Services.
Serves as the primary contact for providers regarding authorization requests.
Contacts members and providers concerning regulatory requirements relating to Department of Health (DOH) notifications and other regulatory requirements such as the National Committee for Quality Assurance (NCQA) guidelines.
Provides timely response to all research inquiries from other departments and assures the response is thorough, accurate, and within regulatory timeframes.
Processes fax requests from the designated fax and system queues.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.

Level II (in addition to Level I Accountabilities)

Assists and performs tasks associated with project and departmental management.
Backup Team Leads by assisting with questions when needed.
Work on assigned offline projects.
Provides, prepares, and assists with preliminary support to multiple levels of providers and or members (as well as others as needed), including but not limited to physicians, skilled nursing facilities, mid-level providers, members, pharmacies, pharmacists, and support staff.
Provide one-on-one support, coaching, and training to UM Services Reps.
Collaborates with other key departments (Claims, Customer Service, related care management units) to ensure end-to-end process for authorizations, telephonic notifications, and/or care management referrals is accurate and complete.

Level III (in addition to Level II Accountabilities)

Assists Team Leads with assigned tasks when necessary (including but not limited to authorizations, claims, care management referrals, monitoring and controlling inventory levels/call queues, timeliness, reporting).
Meet departmental requirements for Facets UM Services workflows and PEGA.
Resolves escalated customer questions and complex concerns.
Assists Medical Directors with scheduling Fair Hearings.
Assists with coordinating Grievance and Appeals requests.
Assist with all Blue Card Claims escalations.
Assist management with the review and creation of desk level procedures, acting as a subject matter expert for UM Services.

Minimum Qualifications:

NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

All Levels

High School Diploma or GED.
Experience with using a desktop computer in a professional environment, preferably with Microsoft Office Products.
Call center experience preferred, not required.
Strong analytical and problem-solving skills.
Strong written and verbal communication skills and ability to work within a team.
Demonstrated organizational skills to manage multiple projects and priorities.
Self-motivated and able to work independently, as well as on intra- and inter-departmental teams where needed.

Level II (in addition to Level I Qualifications)

2 years’ experience working with managed care or healthcare industry.
Ability to apply in-depth knowledge of complex rules, such as those of the authorization process, regulatory processes/time frames, care management systems and processes, departmental policies and procedures, product lines, and contract benefits.
Advanced skills working between multiple programs and applications simultaneously.
Demonstrates willingness to develop collaborative solutions to achieve a better end-to-end process.
Demonstrates proficiency in basic navigation and utilization of department specific applications.
Demonstrates role-specific competencies as it pertains to their work unit on a consistent basis.
Active demonstration of broad knowledge base and positive work habits as evidenced by ability to train new staff, take on new challenges, flexibility in work assignments, and participation in meetings and projects as assigned.

Level III (in addition to Level II Qualifications)

4 years’ experience working with managed care or healthcare industry.
Demonstrates a thorough knowledge and understanding of sources of information about health plan contracts, riders, policy statements, and procedures to identify eligibility and coverage and assisting other staff and other areas within the company with related inquiries.
Demonstrates operational knowledge of FACETS application and workflow processes
Ability to resolve/respond to customer inquiries across multiple plans with limited assistance.
Ability to collaborate within the organization when issues arise with limited assistance.
Ability to identify potential systemic issues and report as necessary without supervisor assistance.

Physical Requirements:

Ability to work prolonged periods sitting at a workstation and working on a computer.
Ability to work while sitting and/or standing while at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
Ability to work in a home office for continuous periods of time for business continuity.
Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
Manual dexterity including fine finger motion required.
Repetitive motion required.
The ability to hear, understand and speak clearly while using a phone, with or without a headset.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Level I: Grade N3: Minimum: $20.40 - Maximum: $27.00

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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More about this job

Skills

Administrative support
Provide information
Quality assurance
Research
Guide staff
Coaching
Customer service
Reporting
Scheduling
Decision making
Microsoft Office
Problem solving
Communication skills
Organizational skills
Work independently
Train crew members
Workflow

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