Remote Utilization Management Associate I

Elevance Health; Las Vegas (NV); Hybrid; USD 23,000 - 38,000; Full time

Job summary

Elevance Health is seeking a Utilization Management Representative I – Backoffice Support in a hybrid/virtual work arrangement. The role processes precertification, prior authorization, and post-service requests for governmental and commercial lines, with minimal inbound calls and some outbound outreach as needed.

Responsibilities include accurate data entry into management systems, preparing clear fax communications, and ensuring compliance with HIPAA, privacy, and security requirements.

Qualifications

• Administrative support, healthcare operations, data entry, document processing, or back-office experience strongly preferred.
• Medical terminology training and experience in medical or insurance field preferred.
• For URAC accredited areas, strong oral, written and interpersonal communication, problem-solving, facilitation, and analytical skills.

Responsibilities

• Reviews and processes utilization management requests received through fax, electronic queues, and other approved channels.
• Accurately enters referral and authorization information into utilization management systems.
• Prepares and sends clear, complete, and accurate fax correspondence to providers, facilities, members, and internal partners.
• Meets departmental productivity, quality, accuracy, and turnaround-time standards while maintaining a low error rate.
• Verifies benefits and administrative requirements within the scope of the role.
• Documents all actions and correspondence accurately and completely.
• Protects confidential information and complies with HIPAA and related requirements.

Skills

Administrative support

Healthcare operations

Data entry

Back-office experience

HIPAA knowledge

Education

HS diploma or GED

Medical terminology training

Job description

Elevance Health is seeking a Utilization Management Representative I – Backoffice Support in a hybrid/virtual work arrangement. The role processes precertification, prior authorization, and post-service requests for governmental and commercial lines, with minimal inbound calls and some outbound outreach as needed.

Responsibilities include accurate data entry into management systems, preparing clear fax communications, and ensuring compliance with HIPAA, privacy, and security requirements.