Remote Utilization Management Associate I

The Elevance Health Companies, Inc.; Louisville (KY); Remoto; USD 35.000 - 55.000; Tempo pieno

Vantaggi offerti da questo lavoro

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical insurance

Dental insurance

Vision insurance

Short-term disability benefits

Long-term disability benefits

401(k) + match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Descrizione del lavoro

Elevance Health is seeking a Utilization Management Representative I (US) for a remote role with occasional in-person training sessions. The position emphasizes flexibility, autonomy, and onboarding to develop essential UM skills.

Responsibilities include handling calls and referrals, verifying eligibility, authorizing care, and collaborating with nurses and other teams to resolve inquiries while maintaining strong customer relations.

Competenze

• Medical terminology training and experience in medical or insurance field preferred.
• Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
• Minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.

Mansioni

• Handle incoming calls and post services claims. Determine contract and benefit eligibility; provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
• Refer cases requiring clinical review to a Nurse reviewer. Data-entry of referral requests into the UM system. Respond to inquiries from clients, providers and in-house departments.
• Conduct clinical screening. Authorize initial set of sessions to provider. Check benefits for facility-based treatment. Maintain positive customer relations and coordinate with various functions to ensure timely handling of requests.

Conoscenze

Customer service

Communication skills

Problem-solving

Analytical skills

Formazione

HS diploma or GED

Descrizione del lavoro

Elevance Health is seeking a Utilization Management Representative I (US) for a remote role with occasional in-person training sessions. The position emphasizes flexibility, autonomy, and onboarding to develop essential UM skills.

Responsibilities include handling calls and referrals, verifying eligibility, authorizing care, and collaborating with nurses and other teams to resolve inquiries while maintaining strong customer relations.