Remote Utilization Management Associate I

Elevance Health, Inc.; Durham (NC); Remote; USD 42,000 - 54,000; Full time

Job summary

Elevance Health, Inc. is seeking a Utilization Management Representative I to coordinate precertification and prior authorization reviews.

The role supports virtual, full-time work with in-person training, with occasional in-office requirements and potential alternate locations within commuting distance. Responsibilities include handling calls, determining eligibility, authorizing admissions and pre/post service requests, and coordinating with nurse reviewers to ensure accurate and timely

Qualifications

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

Responsibilities

• Manage incoming calls and post-service claims work.
• Determine contract and benefit eligibility.
• Provide authorizations for inpatient, outpatient precertification, and post-service requests.
• Refer cases requiring clinical review to a Nurse reviewer.
• Input referral requests into the UM system per plan certificate.
• Respond to inquiries from clients, providers and internal teams.
• Conduct clinical screening and authorize initial provider sessions.
• Verify facility-based treatment benefits and coordinate with teams.

Skills

Customer Service

Call Center Experience

Medical Terminology

Education

HS diploma or GED

Job description

Elevance Health, Inc. is seeking a Utilization Management Representative I to coordinate precertification and prior authorization reviews.

The role supports virtual, full-time work with in-person training, with occasional in-office requirements and potential alternate locations within commuting distance. Responsibilities include handling calls, determining eligibility, authorizing admissions and pre/post service requests, and coordinating with nurse reviewers to ensure accurate and timely