Remote Utilization Management Associate I

Elevance Health, Inc.; Woodbridge Township (NJ); À distance; USD 23 000 - 38 000; Plein temps

Avantages offerts par ce poste

Virtual/Remote work

Flexible scheduling

Résumé du poste

Elevance Health is hiring an Utilization Management Representative I (US) to coordinate precertification and prior authorization reviews. The role supports virtual work with occasional in-person sessions and requires strong communication skills.

The position emphasizes handling inquiries, correctness in UM entries, and collaboration with nurse reviewers. A valid HS diploma and 1 year of customer service experience are required.

Qualifications

• Minimum of 1 year of customer service or call-center experience.
• HS diploma or GED required; equivalent education/experience considered.

Responsabilités

• Handle inbound calls and other communications from clients and providers.
• Determine contract and benefit eligibility for requests.
• Provide authorization for inpatient and outpatient services and prior authorizations.
• Refer cases to Nurse reviewers for clinical review as needed.
• Enter referral requests into the UM system per plan certificate.
• Respond to inquiries from clients, providers, and internal teams.
• Conduct initial clinical screening and authorize initial provider sessions.
• Verify benefits for facility-based treatment and coordinate issue resolution.

Connaissances

Customer service

Call center

Formation

HS diploma or GED

Description du poste

Elevance Health is hiring an Utilization Management Representative I (US) to coordinate precertification and prior authorization reviews. The role supports virtual work with occasional in-person sessions and requires strong communication skills.

The position emphasizes handling inquiries, correctness in UM entries, and collaboration with nurse reviewers. A valid HS diploma and 1 year of customer service experience are required.