Remote Utilization Management Associate I

Elevance Health; Tampa (FL); Hybrid; USD 42,000 - 60,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews. The role supports a flexible hybrid schedule with virtual work and required in-person training sessions, and includes interaction with clients, providers, and internal teams.

Responsibilities include determining eligibility, authorizing initial treatment sessions, and coordinating with nurse reviewers to ensure timely, accurate decisions.

Qualifications

• Requires HS diploma or GED and at least 1 year of customer service or call-center experience.
• Strong verbal and written communication skills.
• Ability to multi-task and handle calls, messages, and inquiries efficiently.

Responsibilities

• Coordinates cases for precertification and prior authorization review.
• 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.
• Performs data entry of referral requests into the UM system in accordance with the plan certificate.
• Responds to telephone and written inquiries from clients, providers and in-house departments.
• Conducts clinical screening process and authorizes initial set of sessions.

Skills

Customer service

Multitasking

Verbal communication

Telephone handling

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 a flexible hybrid schedule with virtual work and required in-person training sessions, and includes interaction with clients, providers, and internal teams.

Responsibilities include determining eligibility, authorizing initial treatment sessions, and coordinating with nurse reviewers to ensure timely, accurate decisions.