Remote Utilization Management Associate I

Elevance Health; Florida; Hybrid; USD 28,000 - 34,000; Full time

Job summary

Elevance Health seeks an Utilization Management Representative I to support contract and benefit eligibility, inpatient/outpatient authorization, and post-service requests. This role is primarily virtual with required in-person training, and some office time per week as per policy.

You'll handle calls and referrals, coordinate with nurse reviewers when needed, and maintain customer relations while navigating complex UM processes in a fast-paced environment.

Qualifications

• HS diploma or GED and a minimum of 1 year of customer service or call-center experience.
• Inbound call center experience preferred.
• URAC accreditation areas require strong oral, written and interpersonal communication, problem-solving, facilitation, and analytical skills.

Responsibilities

• Managing incoming calls or post services claims work.
• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post-service requests.
• Refers cases requiring clinical review to a Nurse reviewer.
• Identity and data entry of referral requests into the UM system per plan certificate.
• Responds to inquiries from clients, providers and in-house departments.
• Conducts clinical screening process.

Skills

Customer service

Call center experience

Medical terminology

Education

High School Diploma or GED

Job description

Elevance Health seeks an Utilization Management Representative I to support contract and benefit eligibility, inpatient/outpatient authorization, and post-service requests. This role is primarily virtual with required in-person training, and some office time per week as per policy.

You'll handle calls and referrals, coordinate with nurse reviewers when needed, and maintain customer relations while navigating complex UM processes in a fast-paced environment.