Remote Utilization Management Rep I

Elevance Health; Atlanta (GA); Hybrid; USD 42,000 - 60,000; Full time

Job summary

Elevance Health is hiring an Utilization Management Representative I to coordinate precertification and prior authorization reviews. The role offers virtual full-time work with in-person training sessions and occasional office time for hybrid collaboration.

The position requires a HS diploma or GED and at least one year of customer service or call-center experience. You will handle inbound calls, verify eligibility, and authorize initial sessions while maintaining strong client relations and

Qualifications

• Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience.
• Inbound call center experience strongly preferred.
• Medical terminology training and experience in medical or insurance field strongly preferred.
• Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, 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.
• Additional expectations to include but not limited to: 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 experience

Medical terminology

Interpersonal communication

Education

HS diploma or GED

Job description

Elevance Health is hiring an Utilization Management Representative I to coordinate precertification and prior authorization reviews. The role offers virtual full-time work with in-person training sessions and occasional office time for hybrid collaboration.

The position requires a HS diploma or GED and at least one year of customer service or call-center experience. You will handle inbound calls, verify eligibility, and authorize initial sessions while maintaining strong client relations and