Remote Utilization Management Associate I

Elevance Health, Inc.; Leawood (KS); Remote; USD 25,000 - 39,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I (US) to coordinate precertification and prior authorization reviews. The role supports a fully remote workflow with occasional in-person training, and may consider alternate locations within commuting distance.

Training spans remote sessions, followed by a standard schedule. You will manage calls, verify eligibility, authorize services, and escalate for clinical review when needed.

Qualifications

• Requires HS diploma or GED and 1 year of customer service or call-center experience.
• Experience in a medical or insurance field preferred.
• For URAC accredited areas, strong oral, written and interpersonal skills, problem-solving, facilitation and analytics.

Responsibilities

• Coordinate cases for precertification and prior authorization review.
• Manage incoming calls or post services claims work.
• Determine contract and benefit eligibility.
• Provide authorization for inpatient, outpatient precertification and post-service requests.
• Refer cases requiring clinical review to a Nurse reviewer.
• Enter referral requests into the UM system per plan certificate.
• Respond to inquiries from clients, providers and internal teams.
• Conduct clinical screening and authorize initial sessions to providers.
• Check benefits for facility-based treatment.
• Maintain positive customer relations and coordinate across functions.

Skills

Customer service

Call center

Medical terminology

Communication skills

Education

HS diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I (US) to coordinate precertification and prior authorization reviews. The role supports a fully remote workflow with occasional in-person training, and may consider alternate locations within commuting distance.

Training spans remote sessions, followed by a standard schedule. You will manage calls, verify eligibility, authorize services, and escalate for clinical review when needed.