Remote Utilization Management Rep I

Elevance Health; Metairie (LA); Hybrid; USD 38,000 - 48,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews, handling incoming calls and post-service requests. The role requires multitasking and strong communication, with familiarity in medical terminology and insurance processes.

The position supports a hybrid/remote work setup with training in person and occasional overtime; flexibility and teamwork are essential to ensure timely and accurate decisions for member care.

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.
• For URAC accredited areas, strong oral, written and interpersonal communication skills, problem-solving, facilitation and analytical skills.

Responsibilities

• Manage incoming calls and post services claims work.
• Determine contract and benefit eligibility; authorize inpatient admissions, outpatient precertification, prior authorization, and post service requests.
• Refer cases requiring clinical review to a Nurse reviewer.
• Enter referral requests into the UM system according to the plan certificate.
• Respond to inquiries from clients, providers and in-house departments.
• Conduct clinical screening process.
• Authorize initial set of sessions to provider.
• Check benefits for facility-based treatment.
• Coordinate with various functions to address customer requests promptly.
• Maintain focus and multi-task across calls, texts, and queues.
• Demonstrate empathy, persistence, and proficiency with digital tools.
• Work schedule with occasional overtime and potential office presence.
• Performs other duties as assigned.

Skills

Inbound call center

Medical terminology

Communication skills

Multi-tasking

Problem-solving

Education

HS diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews, handling incoming calls and post-service requests. The role requires multitasking and strong communication, with familiarity in medical terminology and insurance processes.

The position supports a hybrid/remote work setup with training in person and occasional overtime; flexibility and teamwork are essential to ensure timely and accurate decisions for member care.