Remote Utilization Management Associate I

Elevance Health; Meridian (ID); Hybrid; USD 42,000 - 54,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I to coordinate cases for precertification and prior authorization review, in a fast-paced, member-facing setting. The role requires a high school diploma or GED and at least one year of customer service or call-center experience; inbound call center experience and medical terminology knowledge are preferred.

You will work rotating weekends, holidays, and time-zone aligned shifts with hybrid/remote options.

Qualifications

• HS diploma or GED required.
• 1 year of customer service or call-center experience required.
• Inbound call center experience preferred.
• Medical terminology training and experience in medical/insurance field preferred.
• URAC competencies include strong communication, problem-solving and analytical skills.

Responsibilities

• Manage incoming calls and post service claims work.
• Determine contract and benefit eligibility; authorize inpatient admission, outpatient precertification, prior authorization, and post-service requests.
• Refer cases needing clinical review to a Nurse reviewer.
• Enter referral requests into the UM system in accordance with the plan certificate.
• Respond to inquiries from clients, providers, and in-house departments.
• Conduct clinical screening process and authorize initial set of sessions.
• Check benefits for facility-based treatment and coordinate with various functions to handle requests.
• Maintain positive customer relations and multitask across calls, texts, and queues.

Skills

Customer service

Call center

Medical terminology

Education

High School Diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I to coordinate cases for precertification and prior authorization review, in a fast-paced, member-facing setting. The role requires a high school diploma or GED and at least one year of customer service or call-center experience; inbound call center experience and medical terminology knowledge are preferred.

You will work rotating weekends, holidays, and time-zone aligned shifts with hybrid/remote options.