Remote Utilization Management Associate I

Elevance Health; Meridian (ID); Hybrid; USD 36,000 - 52,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews. The role supports flexible work arrangements with virtual duties and required in-person training sessions, and occasional office attendance.

The candidate will handle calls and claims, determine eligibility, authorize services, and escalate complex cases to Nurse reviewers while maintaining strong customer relations and accurate data entry in the UM system.

Qualifications

• Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience.

Responsibilities

• Coordinates precertification and prior authorization reviews.
• Determines contract and benefit eligibility; authorizes services.
• Refers cases requiring clinical review to a Nurse reviewer.
• Performs data entry of referral requests into the UM system.
• Responds to inquiries from clients, providers and internal teams.
• Conducts clinical screening and authorizes initial sessions.
• Maintains positive customer relations and multitasks across channels.
• Flexible with time zones and occasional overtime.

Skills

Inbound call center experience

Medical terminology training

Strong communication skills

Education

HS diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews. The role supports flexible work arrangements with virtual duties and required in-person training sessions, and occasional office attendance.

The candidate will handle calls and claims, determine eligibility, authorize services, and escalate complex cases to Nurse reviewers while maintaining strong customer relations and accurate data entry in the UM system.