Remote Utilization Management Rep I

Elevance Health; New York (NY); Remote; USD 42,000 - 62,000; Full time

Job summary

Elevance Health is seeking a Utilization Management Rep I for virtual work with occasional in-person training. The role involves handling calls, processing referrals, and authorizing initial treatment sessions, with a focus on accuracy and empathy.

Responsibilities include data entry, responding to inquiries, and coordinating with multiple functions to resolve customer needs. Strong communication and multitasking are essential in a fast-paced environment.

Qualifications

• HS diploma or GED.
• Minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.

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.
• 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

Communication

Education

HS diploma or GED

Job description

Elevance Health is seeking a Utilization Management Rep I for virtual work with occasional in-person training. The role involves handling calls, processing referrals, and authorizing initial treatment sessions, with a focus on accuracy and empathy.

Responsibilities include data entry, responding to inquiries, and coordinating with multiple functions to resolve customer needs. Strong communication and multitasking are essential in a fast-paced environment.