Remote Utilization Management Coordinator I

Elevance Health; Independence Township (OH); Remote; USD 42,000 - 54,000; Full time

Job summary

Elevance Health is seeking a Utilization Management Representative I to coordinate precertification and prior authorization reviews. This full-time role supports calls, post services work, and data entry into the UM system with accuracy and efficiency.

Responsibilities include determining eligibility, authorizing initial sessions, and referring complex cases to Nurse reviewers while maintaining strong customer relations across functions in a remote/hybrid environment.

Qualifications

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

Responsibilities

• Coordinate cases for precertification and prior authorization review.
• Determine contract and benefit eligibility; provide authorization for inpatient admission and other services.
• Refer cases requiring clinical review to a Nurse reviewer.
• Enter referral requests into the UM system with accuracy.
• Respond to inquiries from clients, providers and internal teams.

Skills

Customer service

Communication

Multi-tasking

Empathy

Digital tools

Education

HS diploma or GED

Medical terminology training (preferred)

Tools

UM system

Job description

Elevance Health is seeking a Utilization Management Representative I to coordinate precertification and prior authorization reviews. This full-time role supports calls, post services work, and data entry into the UM system with accuracy and efficiency.

Responsibilities include determining eligibility, authorizing initial sessions, and referring complex cases to Nurse reviewers while maintaining strong customer relations across functions in a remote/hybrid environment.