Remote Utilization Management Coordinator I

Elevance Health; Boght Corners (NY); Remote; USD 23,000 - 29,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I for a remote/virtual position with optional in-person sessions. The role involves coordinating precertification and prior authorization reviews, handling calls and referrals, and maintaining strong client communication.

Minimum qualifications include a HS diploma or GED and at least 1 year in customer service or a call center. The company emphasizes flexible scheduling and adherence to high-quality service standards in a

Qualifications

• HS diploma or GED required.
• Minimum of 1 year of customer service or call-center experience.

Responsibilities

• Manage 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

Medical terminology

Communication skills

Interpersonal skills

Multitasking

Customer service

Education

HS diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I for a remote/virtual position with optional in-person sessions. The role involves coordinating precertification and prior authorization reviews, handling calls and referrals, and maintaining strong client communication.

Minimum qualifications include a HS diploma or GED and at least 1 year in customer service or a call center. The company emphasizes flexible scheduling and adherence to high-quality service standards in a