Remote Utilization Management Associate II

Elevance Health; Tampa (FL); Hybrid; USD 42,000 - 62,000; Full time

Job summary

Elevance Health and BioPlus Specialty Pharmacy seek a qualified Utilization Management Representative II for a full-time role with flexible virtual work and in-person training requirements. The position will be based in Tampa, FL, with alternate locations considered within commuting distance.

The role includes handling calls, authorizations, and payer coordination. The incumbent will verify benefits, determine eligibility, and support clinical review processes while collaborating with providers

Qualifications

• HS diploma or equivalent; 2 years of customer service experience in a healthcare setting.
• Medical terminology training or equivalent background.

Responsibilities

• Manage incoming calls and triage; open cases and authorize sessions.
• Provide prior authorization decisions for inpatient/outpatient services and post-service requests.
• Obtain intake information from callers and verify eligibility.
• Perform radius searches in Provider Finder and coordinate referrals.
• Refer cases requiring clinical review to a nurse reviewer; handle specialty referrals.
• Screen and collect documents for review to meet payer criteria; review clinical notes and labs as applicable.
• Verify benefits with commercial insurance, Medicare/Medicaid, and PBMs as needed.
• Coordinate with Medical Management and internal departments as needed.
• Respond to inquiries and communicate authorization status; support denial follow-up with needed information.
• Document authorization details in the system.

Skills

Excel

HCPCS/J-codes

ICD-10 coding

EMR systems

Prior auth portals

Insurance guidelines

Education

HS diploma

Tools

Epic

WebRx

CPR+

Job description

Elevance Health and BioPlus Specialty Pharmacy seek a qualified Utilization Management Representative II for a full-time role with flexible virtual work and in-person training requirements. The position will be based in Tampa, FL, with alternate locations considered within commuting distance.

The role includes handling calls, authorizations, and payer coordination. The incumbent will verify benefits, determine eligibility, and support clinical review processes while collaborating with providers