Remote Utilization Management Coordinator I

Elevance Health; Virginia (MN); Remote; USD 40,000 - 55,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews. This remote role involves handling calls, reviewing benefits, and coordinating with nurses for clinical reviews. Training occurs with in-person sessions, with occasional office work required.

Ideal candidates have a HS diploma or GED and 1 year of customer service experience, strong communication skills, and comfort with digital tools and fast-paced environments.

Qualifications

• HS diploma or GED and a minimum of 1 year of customer service or call-center experience.

Responsibilities

• Manage incoming calls and post service claims work.
• Determine contract and benefit eligibility; authorize inpatient, outpatient precertification, and post service requests.
• Refer cases requiring clinical review to a Nurse reviewer.
• Enter referral requests into the UM system per plan certificate.
• Respond to inquiries from clients, providers and internal teams.
• Conduct clinical screening and authorize initial sessions.
• Check benefits for facility-based treatment.
• Maintain positive customer relations and coordinate with functions across the company.
• Multitask across calls, texts, faxes and queues while taking notes.

Skills

Verbal communication

Written communication

Empathy

Multi-tasking

Digital tools

Education

HS diploma or GED

Tools

UM system

Job description

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews. This remote role involves handling calls, reviewing benefits, and coordinating with nurses for clinical reviews. Training occurs with in-person sessions, with occasional office work required.

Ideal candidates have a HS diploma or GED and 1 year of customer service experience, strong communication skills, and comfort with digital tools and fast-paced environments.