Remote Utilization Coordinator I

Elevance Health (Anthem); Louisville (KY); Remote; USD 37,000 - 55,000; Full time

Benefits offered by this job

Medical

Dental

401(k) + match

Paid time off

Job summary

Elevance Health in the United States is seeking a Utilization Management Representative I to coordinate precertification and prior authorization reviews. This remote role offers full-time hours with occasional in-person training sessions.

You will handle calls and post-service requests, verify eligibility, refer cases for clinical review, and document referrals in the UM system while delivering responsive, empathetic service to providers and members.

Qualifications

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

Responsibilities

• Manages incoming calls and post-service claims work.
• Determines eligibility and provides authorization for inpatient, precertification, and prior authorization.
• Refs cases requiring clinical review to a Nurse reviewer.
• Enters referral requests into the UM system per plan.
• Responds to inquiries from clients, providers and internal teams.
• Performs clinical screening and authorizes initial provider sessions.
• Checks benefits for facility-based treatment.
• Maintains positive customer relations and coordinates across functions.
• Multitasks across calls, texts, faxes, and electronic queues.

Skills

Customer service

Call center

Education

HS diploma or GED

Job description

Elevance Health in the United States is seeking a Utilization Management Representative I to coordinate precertification and prior authorization reviews. This remote role offers full-time hours with occasional in-person training sessions.

You will handle calls and post-service requests, verify eligibility, refer cases for clinical review, and document referrals in the UM system while delivering responsive, empathetic service to providers and members.