Remote Utilization & Authorization Specialist

Elevance Health; Seven Fields (Butler County); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical

Dental

Vision

Short and long term disability

401(k) +match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Job summary

Elevance Health is hiring a Utilization Management Representative I for a virtual, full-time role with occasional in-person training. You will coordinate precertification and prior authorization, review contracts and benefits, and support clients, providers, and internal teams.

The role requires strong communication, clinical screening, and the ability to multitask in a fast-paced environment while maintaining empathy and attention to detail.

Qualifications

• HS diploma or GED required.
• Minimum of 1 year of customer service or call-center experience.
• Medical terminology knowledge preferred.

Responsibilities

• Coordinate cases for precertification and prior authorization review.
• Manage incoming calls and post services claims work.
• Determine contract and benefit eligibility; authorize inpatient/precertification and post-service requests.
• Refer cases needing clinical review to a Nurse reviewer.
• Enter referral requests into the UM system per plan certificate.
• Respond to inquiries from clients, providers and internal teams.
• Conduct clinical screening processes and authorize initial sessions.
• Check benefits for facility-based treatment and coordinate with other functions.
• Multitask across calls, texts, faxes, and electronic queues while taking notes.
• Maintain focus in fast-paced environment and demonstrate empathy and persistence.

Skills

Customer service

Call center experience

Medical terminology

Interpersonal communication

Problem-solving

Education

HS diploma or GED

Tools

UM system

Job description

Elevance Health is hiring a Utilization Management Representative I for a virtual, full-time role with occasional in-person training. You will coordinate precertification and prior authorization, review contracts and benefits, and support clients, providers, and internal teams.

The role requires strong communication, clinical screening, and the ability to multitask in a fast-paced environment while maintaining empathy and attention to detail.