Remote Utilization Management Rep I

Elevance Health; Virginia Beach (VA); On-site; USD 22,000 - 25,000; Full time

Job summary

Elevance Health is seeking a Utilization Management Representative I for a virtual, full-time role with occasional in-person training. The position supports precertification, prior authorization, and post-service requests, coordinating with nurses as needed.

Primary duties include handling calls, processing referrals, verifying benefits, and maintaining strong customer relations across departments. The role requires at least a HS diploma and 1+ year of customer service experience.

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.
• Medical terminology training (preferred).
• URAC competencies: strong oral, written and interpersonal communication skills, problem-solving, facilitation and analytical skills.

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.
• Identifies and enters referral requests into the UM system according to the plan certificate.
• Responds to telephone and written inquiries from clients, providers and in-house departments.
• Performs clinical screening processes.

Skills

Customer service

Call center

Education

HS diploma or GED

Job description

Elevance Health is seeking a Utilization Management Representative I for a virtual, full-time role with occasional in-person training. The position supports precertification, prior authorization, and post-service requests, coordinating with nurses as needed.

Primary duties include handling calls, processing referrals, verifying benefits, and maintaining strong customer relations across departments. The role requires at least a HS diploma and 1+ year of customer service experience.