Remote Utilization Management Associate I

Elevance Health, Inc.; Louisville (KY); Híbrido; USD 42 000 - 60 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical

Dental

Vision

401(k) + match

Paid Time Off

Resumo da oferta

Elevance Health, Inc. is seeking an Utilization Management Representative I for a hybrid/remote role. You will coordinate cases for precertification and prior authorization review, manage calls and referrals, and determine contract and benefit eligibility.

You will refer cases requiring clinical review to a Nurse reviewer, enter referral data, respond to inquiries, and support processes to ensure timely, accurate authorizations and patient care.

Qualificações

• 1 year of customer service or call-center experience.
• Medical terminology training and insurance knowledge preferred.

Responsabilidades

• Coordinate cases for precertification and prior authorization review.
• Manage incoming calls and referrals; determine eligibility for benefits and services.
• Refer cases requiring clinical review to a Nurse reviewer.
• Enter referral data into UM system accurately.
• Respond to inquiries from clients, providers and internal teams.

Conhecimentos

Customer service

Formação académica

HS diploma or GED

Descrição da oferta de emprego

Elevance Health, Inc. is seeking an Utilization Management Representative I for a hybrid/remote role. You will coordinate cases for precertification and prior authorization review, manage calls and referrals, and determine contract and benefit eligibility.

You will refer cases requiring clinical review to a Nurse reviewer, enter referral data, respond to inquiries, and support processes to ensure timely, accurate authorizations and patient care.