Remote Utilization Management Rep I

Elevance Health; Latham (NY); Remote; USD 23,000 - 38,000; Full time

Job summary

Elevance Health is seeking a Utilization Management Representative I (US) to coordinate precertification and prior authorization reviews in a flexible, virtual environment with in-person onboarding as needed.

You will manage calls and claims, determine eligibility, and authorize services while collaborating with Nurse reviewers and internal teams to ensure timely, accurate processing.

Qualifications

• Requires HS diploma or GED plus 1 year of customer service or call-center experience.
• Experience in a medical or insurance field preferred.

Responsibilities

• Coordinate cases for precertification and prior authorization review.
• Manage incoming calls and claims work.
• Determine contract and benefit eligibility.
• Provide authorization for inpatient admission, outpatient precertification, prior authorization, and post-service requests.
• Refer cases to a Nurse reviewer for clinical review.
• Enter referral requests into the UM system per plan certificate.
• Respond to inquiries from clients, providers and internal departments.
• Conduct clinical screening and authorize initial set of sessions.
• Check benefits for facility-based treatment.
• Maintain positive customer relations and coordinate with various functions.

Skills

Medical terminology training

Customer service experience

Oral communication

Written communication

Interpersonal communication

Education

HS diploma or GED

Job description

Elevance Health is seeking a Utilization Management Representative I (US) to coordinate precertification and prior authorization reviews in a flexible, virtual environment with in-person onboarding as needed.

You will manage calls and claims, determine eligibility, and authorize services while collaborating with Nurse reviewers and internal teams to ensure timely, accurate processing.