Remote Utilization Management Rep I

Elevance Health; Hermitage (Mercer County); Hybrid; USD 38,000 - 48,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Disability benefits

401(k) + match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Job summary

Elevance Health is seeking an Utilization Management Representative I to coordinate cases for precertification and prior authorization review. This role supports virtual work with occasional in-person training and requires strong communication with clients and providers.

You will handle calls and inquiries, determine eligibility, and refer cases for clinical review. A 1-year customer service background and healthcare terminology knowledge are preferred.

Qualifications

• HS diploma or GED required.
• Minimum 1 year of customer service or call-center experience.
• Healthcare terminology knowledge is a plus.

Responsibilities

• Coordinate cases for precertification and prior authorization review.
• Handle calls and inquiries from clients and providers.
• Determine contract and benefit eligibility and authorize services as appropriate.
• Refer cases to Nurse reviewer for clinical review when needed.
• Maintain accurate data entry into the UM system and document referrals.

Skills

Customer service

Call center

Communication

Education

HS diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I to coordinate cases for precertification and prior authorization review. This role supports virtual work with occasional in-person training and requires strong communication with clients and providers.

You will handle calls and inquiries, determine eligibility, and refer cases for clinical review. A 1-year customer service background and healthcare terminology knowledge are preferred.