Remote Utilization Management Associate I

Elevance Health, Inc.; Wilmington (DE); Remote; USD 23,000 - 38,000; Full time

Job summary

Elevance Health, Inc. is seeking a Utilization Management Representative I (US) to coordinate precertification and prior authorization reviews. This virtual role offers flexibility with in-person training and occasional office presence within a commuting distance.

You will handle calls and claims work, determine eligibility, and authorize services while maintaining strong customer relations. The position requires a HS diploma or GED and 1 year of customer service or call-center experience;

Qualifications

• HS diploma or GED required
• 1 year of customer service or call-center experience preferred
• Experience in medical or insurance field is a plus
• URAC-accredited areas require strong communication and analytical skills

Responsibilities

• Coordinate cases for precertification and prior authorization review
• Manage incoming calls and post services claims work
• Determine contract and benefit eligibility
• Provide authorization for inpatient, outpatient precertification, prior authorization and post-service requests
• Refer cases to Nurse reviewer when clinical review is needed
• Enter referral requests into UM system per plan certificate
• Respond to inquiries from clients, providers and internal teams
• Conduct clinical screening process
• Authorize initial set of sessions to provider
• Check benefits for facility-based treatment
• Maintain positive customer relations and collaborate with internal teams
• Handle multiple tasks across calls, texts, and queues
• Stay focused in fast-paced environment
• Demonstrate strong verbal and written communication skills
• Use digital tools to enhance productivity
• Work a structured schedule with possible overtime or office presence as needed
• Perform other duties as assigned

Skills

Customer service

Call-center

Communication

Empathy

Job description

Elevance Health, Inc. is seeking a Utilization Management Representative I (US) to coordinate precertification and prior authorization reviews. This virtual role offers flexibility with in-person training and occasional office presence within a commuting distance.

You will handle calls and claims work, determine eligibility, and authorize services while maintaining strong customer relations. The position requires a HS diploma or GED and 1 year of customer service or call-center experience;