Remote Utilization Management Coordinator I

Elevance Health; Louisville (KY); Remote; USD 40,000 - 60,000; Full time

Job summary

Elevance Health seeks a diligent Utilization Management Representative I to coordinate precertification and prior authorization review on a virtual basis. The role emphasizes flexibility with required in-person training and occasional office presence when needed.

You will manage calls and referrals, verify eligibility, authorize services, and collaborate with a Nurse reviewer for clinical review, while maintaining empathy and clear communication with clients, providers and internal teams.

Qualifications

• HS diploma or GED.
• Minimum of 1 year of customer service or call-center experience; or equivalent background.
• Medical terminology training and experience in medical or insurance field preferred.
• URAC accredited areas require strong oral, written and interpersonal communication skills, problem-solving, facilitation and analytical skills.

Responsibilities

• Managing 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

Customer service

Call center

Communication skills

Medical terminology

Analytical skills

Problem-solving

Interpersonal skills

Education

HS diploma or GED

Job description

Elevance Health seeks a diligent Utilization Management Representative I to coordinate precertification and prior authorization review on a virtual basis. The role emphasizes flexibility with required in-person training and occasional office presence when needed.

You will manage calls and referrals, verify eligibility, authorize services, and collaborate with a Nurse reviewer for clinical review, while maintaining empathy and clear communication with clients, providers and internal teams.