Remote Utilization Management Rep I

Elevance Health; Indianapolis (IN); Hybrid; USD 38,000 - 52,000; Full time

Job summary

Elevance Health seeks a Utilization Management Representative I who coordinates precertification and prior authorization reviews. The role supports virtual work with required in-person training, and candidates must reside within a 30-40 mile radius of Indianapolis, IN or Midland, GA.

You will handle calls and claims, determine eligibility, authorize care, and refer complex cases to nurses. The position emphasizes empathy, clear communication, multitasking in a fast-paced environment, and

Qualifications

• HS diploma or GED.
• Minimum of 1 year of customer service or call-center experience.
• Medical terminology training preferred.
• URAC competencies include strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Responsibilities

• Handling incoming calls and post services claims work.
• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
• Refs cases requiring clinical review to a Nurse reviewer.
• Data entry of referral requests into the UM system per plan certificate.
• Responds to inquiries from clients, providers and in-house departments.
• Performs clinical screening process.
• Authorizes initial set of sessions to provider.
• Checks benefits for facility-based treatment.
• Maintains positive customer relations and coordinates with functions to handle requests promptly.
• Works multiple tasks including calls, texts, facsimiles, and electronic queues while taking notes and speaking to customers.
• Maintains focus in a fast-paced environment with attention to detail.

Skills

Customer service

Call center

Education

HS diploma or GED

Job description

Elevance Health seeks a Utilization Management Representative I who coordinates precertification and prior authorization reviews. The role supports virtual work with required in-person training, and candidates must reside within a 30-40 mile radius of Indianapolis, IN or Midland, GA.

You will handle calls and claims, determine eligibility, authorize care, and refer complex cases to nurses. The position emphasizes empathy, clear communication, multitasking in a fast-paced environment, and