Remote: Entry-Level Utilization Management Specialist

The Elevance Health Companies, Inc.; Costa Mesa (CA); Hybrid; USD 22,000 - 38,000; Full time

Benefits offered by this job

Comprehensive benefits package

401k contribution

Stock purchase program

Incentive and recognition programs

Medical, dental, vision, disability

Job summary

Elevance Health is seeking a Utilization Management Representative I. This role supports managing calls, eligibility determinations, precertifications, and referrals to nurse reviewers. It allows virtual work with required in-person trainings and a hybrid/work-from-office option depending on location.

A structured schedule with occasional overtime and vaccination requirements may apply. This U/M role requires a HS diploma or GED and at least 1 year of customer service experience.

Qualifications

• HS diploma or GED is required.
• 1 year of customer service or call-center experience.
• Medical terminology training and experience in medical or insurance fields preferred.

Responsibilities

• Manage incoming calls and post services claims work.
• Determine contract and benefit eligibility; authorize inpatient admissions, precertification, prior authorization, and post-service requests.
• Refer cases requiring clinical review to a Nurse reviewer.
• Enter referral data into the UM system per plan certificate.
• Respond to inquiries from clients, providers and internal departments.
• Conduct clinical screening processes.
• Authorize initial set of sessions to providers.
• Check benefits for facility-based treatment.
• Maintain positive customer relations and coordinate across functions.
• Perform other duties as assigned.

Education

HS diploma or GED

Job description

Elevance Health is seeking a Utilization Management Representative I. This role supports managing calls, eligibility determinations, precertifications, and referrals to nurse reviewers. It allows virtual work with required in-person trainings and a hybrid/work-from-office option depending on location.

A structured schedule with occasional overtime and vaccination requirements may apply. This U/M role requires a HS diploma or GED and at least 1 year of customer service experience.