Remote Utilization Management Associate I

Elevance Health, Inc.; Ashburn (VA); A distancia; USD 23.000 - 38.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Hybrid/Virtual work options

Flexible schedule

Comprehensive benefits

Descripción de la vacante

Elevance Health, Inc. is seeking an Utilization Management Representative I (US). This remote role supports precertification, prior authorization review, and case coordination across plans via UM systems.

You will handle calls, eligibility checks, and provider communications while maintaining compliance and member focus. The position offers flexible, virtual work with required in-person training and occasional onsite needs.

Formación

• Requires HS diploma or GED and 1 year of customer service or call-center experience.
• Experience in medical or insurance field preferred.
• URAC-accredited areas require strong communication, problem-solving and analytical skills.

Responsabilidades

• Coordinate cases for precertification and prior authorization review.
• Manage calls and provider communications; determine eligibility and benefits.
• Authorize initial set of sessions and check facility-based benefits.
• Refer clinical reviews to Nurse reviewer and enter referrals into UM system.
• Maintain customer relations and respond to inquiries in a timely manner.
• multitask with calls, texts, and electronic queues; ensure accuracy and empathy.

Conocimientos

Customer service

Medical terminology

Insurance knowledge

Communication skills

Educación

HS diploma or GED

Descripción del empleo

Elevance Health, Inc. is seeking an Utilization Management Representative I (US). This remote role supports precertification, prior authorization review, and case coordination across plans via UM systems.

You will handle calls, eligibility checks, and provider communications while maintaining compliance and member focus. The position offers flexible, virtual work with required in-person training and occasional onsite needs.