Remote Utilization Management Rep I – Case Coordination

Elevance Health, Inc.; Louisville (KY); Remote; USD 36,000 - 48,000; Full time

Job summary

Elevance Health seeks an Utilization Management Representative I to coordinate precertification and prior authorization reviews in a flexible virtual environment. This role supports inbound calls, referral processing, and clinical screening as part of the UM team.

You will determine eligibility, authorize initial provider sessions, and maintain positive customer relations across internal and external partners. Hybrid/virtual policy requires onsite activities as needed.

Qualifications

• HS diploma or GED.
• Minimum of 1 year of customer service or call-center experience.
• Medical terminology training and experience in medical or insurance field preferred.
• URAC competencies: strong oral, written and interpersonal communication, problem-solving, facilitation, and analytical skills.

Responsibilities

• Manage incoming calls and post service claims work.
• Determine contract and benefit eligibility; authorize inpatient, outpatient precertification, prior authorization, and post service requests.
• Refer clinical review to a Nurse reviewer.
• Enter referral requests into UM system per plan certificate.
• Respond to inquiries from clients, providers and internal departments.
• Conduct clinical screening process.
• Authorize initial set of sessions to provider.
• Check benefits for facility-based treatment.
• Maintain positive customer relations and coordinate with company functions to handle requests promptly.
• Multitask while handling calls, texts, facsimiles, and electronic queues.

Skills

Customer service

Communication skills

Multitasking

Empathy

Time management

Education

HS diploma or GED

Job description

Elevance Health seeks an Utilization Management Representative I to coordinate precertification and prior authorization reviews in a flexible virtual environment. This role supports inbound calls, referral processing, and clinical screening as part of the UM team.

You will determine eligibility, authorize initial provider sessions, and maintain positive customer relations across internal and external partners. Hybrid/virtual policy requires onsite activities as needed.