Remote Utilization Management Associate I

Elevance Health; Meridian (ID); Hybrid; USD 38,000 - 48,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical

Dental

Vision

Long term disability benefits

401(k) +match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Job summary

Elevance Health in Idaho is seeking an entry-level Utilization Management Representative I to coordinate precertification and prior authorization reviews. You will handle inbound calls, verify benefits, and collaborate with nurses and providers to determine eligibility.

The role offers a hybrid schedule with required in-person training, occasional overtime, and opportunities to grow within a Fortune 25 health company dedicated to member outcomes and equal opportunity.

Qualifications

• Requires HS diploma or GED and at least 1 year in customer service or call center.
• Medical terminology training is preferred.
• URAC competencies include strong oral, written and interpersonal communication, problem solving and analytical skills.

Responsibilities

• Managing incoming calls or incoming post services claims work.
• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
• Refers cases requiring clinical review to a Nurse reviewer.
• Data entry of referral requests into the UM system in accordance with the plan certificate.
• Responds to inquiries from clients, providers and in-house departments.
• Performs clinical screening and authorizes initial set of sessions.
• Checks benefits for facility based treatment.
• Develops and maintains positive customer relations and coordinates with various company functions.

Skills

Customer service

Communication skills

Medical terminology

Education

HS diploma or GED

Job description

Elevance Health in Idaho is seeking an entry-level Utilization Management Representative I to coordinate precertification and prior authorization reviews. You will handle inbound calls, verify benefits, and collaborate with nurses and providers to determine eligibility.

The role offers a hybrid schedule with required in-person training, occasional overtime, and opportunities to grow within a Fortune 25 health company dedicated to member outcomes and equal opportunity.