Remote Utilization Management Associate I

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

Job summary

Elevance Health, Inc. is seeking a Utilization Management Representative I (US) to coordinate cases for precertification and prior authorization review. This role supports a virtual environment with required in-person training sessions and occasional office work as needed.

The position emphasizes handling calls and referrals, determining eligibility, and authorizing services while maintaining strong customer relations and timely responses to stakeholders.

Qualifications

• Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience.
• Medical terminology training is preferred.
• Experience in a medical or insurance field is advantageous.

Responsibilities

• Coordinate cases for precertification and prior authorization review.
• Manage incoming calls and post service claims work.
• Determine contract and benefit eligibility.
• Provide authorization for inpatient admission and outpatient precertification.
• Refer cases to Nurse reviewers for clinical review.
• Respond to inquiries from clients, providers and in-house teams.

Skills

Customer service

Medical terminology

Insurance knowledge

Communication skills

Problem solving

Education

HS diploma or GED

Job description

Elevance Health, Inc. is seeking a Utilization Management Representative I (US) to coordinate cases for precertification and prior authorization review. This role supports a virtual environment with required in-person training sessions and occasional office work as needed.

The position emphasizes handling calls and referrals, determining eligibility, and authorizing services while maintaining strong customer relations and timely responses to stakeholders.