Remote Utilization Management Rep I

Elevance Health; Virginia (MN); Hybrid; USD 42,000 - 54,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews, managing calls and referrals. This role offers virtual work with occasional in-person training and requires HS diploma and 1 year of customer service experience. URAC competencies are preferred.

You will collaborate with nurses and providers to ensure timely decisions, maintain patient relations, and handle multiple tasks in a fast-paced environment.

Qualifications

• HS diploma or GED.
• Minimum of 1 year of customer service or call-center experience; or equivalent education/experience.

Responsibilities

• Manage incoming calls and post service claims work.
• Determine eligibility and authorize inpatient/outpatient approvals.
• Refer cases for clinical review to Nurse reviewers.
• Enter referral requests into the UM system and track status.
• Respond to inquiries from clients, providers and internal teams.
• Conduct clinical screening and authorize initial provider sessions.
• Maintain positive customer relations across functions.
• Multitask across calls, texts, faxes while taking notes.
• Work a structured schedule with potential overtime.

Skills

Customer service

Call center

Communication

Medical terminology

Interpersonal skills

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, managing calls and referrals. This role offers virtual work with occasional in-person training and requires HS diploma and 1 year of customer service experience. URAC competencies are preferred.

You will collaborate with nurses and providers to ensure timely decisions, maintain patient relations, and handle multiple tasks in a fast-paced environment.