Remote Utilization Management Associate I

Elevance Health, Inc.; United States; Remote; USD 25,000 - 39,000; Full time

Job summary

Elevance Health is seeking a Utilization Management Representative I to coordinate precertification and prior authorization reviews in a virtual capacity, with required in-person training sessions. This role offers flexibility and autonomy while promoting productivity and onboarding opportunities.

The position supports inbound calls, eligibility determinations, and referrals to Nurse reviewers. A HS diploma or GED and at least 1 year of customer service or call-center experience are required.

Qualifications

• HS diploma or GED.
• Minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.

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.
• Responsible for the identification and 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.
• Authorizes initial set of sessions to provider.
• Checks benefits for facility based treatment.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
• Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
• Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment.
• Strong verbal and written communication skills, both with virtual and in-person interactions.
• Attentive to details, critical thinker, and a problem-solver.
• Demonstrates empathy and persistence to resolve caller issues completely.
• Comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.
• Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.
• Performs other duties as assigned.

Skills

Customer Service

Call Center

Education

HS diploma or GED

Job description

Elevance Health is seeking a Utilization Management Representative I to coordinate precertification and prior authorization reviews in a virtual capacity, with required in-person training sessions. This role offers flexibility and autonomy while promoting productivity and onboarding opportunities.

The position supports inbound calls, eligibility determinations, and referrals to Nurse reviewers. A HS diploma or GED and at least 1 year of customer service or call-center experience are required.