Remote Utilization Management Associate I

Elevance Health, Inc.; Latham (NY); Remote; USD 23,000 - 38,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I (US) for a virtual role with required in-person training. The position coordinates cases for precertification and prior authorization review, supporting productivity and work-life integration.

The role involves handling calls, determining eligibility, authorizing services, and coordinating with Nurse reviewers and other departments to resolve inquiries efficiently.

Qualifications

• Requires HS diploma or GED and at least 1 year of customer service or call-center experience.
• Healthcare or insurance background is preferred.
• Strong verbal and written communication in a professional setting.

Responsibilities

• Manage incoming calls and post service claims work.
• Determine contract and benefit eligibility.
• Authorize admissions and precertifications as required.
• Refer cases for clinical review to a Nurse reviewer.
• Enter referrals into the UM system per plan certificate.
• Respond to inquiries from clients, providers and internal teams.

Skills

Medical terminology

Insurance experience

URAC standards

Education

HS diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I (US) for a virtual role with required in-person training. The position coordinates cases for precertification and prior authorization review, supporting productivity and work-life integration.

The role involves handling calls, determining eligibility, authorizing services, and coordinating with Nurse reviewers and other departments to resolve inquiries efficiently.