Remote Utilization Management Associate I

Elevance Health; Boght Corners (NY); Remote; USD 23,000 - 38,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I (US) to support virtual operations with occasional in-person training. You will handle calls, determine eligibility, authorize services, and coordinate with nurse reviewers to ensure timely patient care.

The role emphasizes strong communication, attention to detail, and the ability to multitask in a fast-paced environment while maintaining compliance with policies.

Qualifications

• Requires knowledge of medical terminology and claims processing.
• Experience in medical or insurance field preferred.
• URAC accreditation areas require strong communication, problem-solving and analytical skills.

Responsibilities

• Manage incoming calls and post-service claims work.
• Determine contract and benefit eligibility.
• Provide authorization for inpatient admission, precertification and prior authorization.
• Refer cases to Nurse reviewer for clinical review.
• Enter referral requests into the UM system per plan certificate.
• Respond to inquiries from clients, providers and internal departments.
• Conduct clinical screening and authorize initial sessions.
• Check benefits for facility-based treatment.
• Maintain positive customer relations and collaborate across functions.
• Multitask across channels while taking notes and speaking with customers.

Skills

Medical terminology

Insurance experience

URAC knowledge

Education

HS diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I (US) to support virtual operations with occasional in-person training. You will handle calls, determine eligibility, authorize services, and coordinate with nurse reviewers to ensure timely patient care.

The role emphasizes strong communication, attention to detail, and the ability to multitask in a fast-paced environment while maintaining compliance with policies.