Remote Utilization Management Rep I – Case Coordination

The Elevance Health Companies, Inc.; Louisville (KY); On-site; USD 40,000 - 54,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I to handle precertification, prior authorization and post-service requests. The role is virtual, with in-person training and possible office involvement within commuting distance as per policy.

Key duties include coordinating cases, reviewing contracts and benefits, authorizing initial treatment sessions, and assisting providers and clients while maintaining strong customer relations and efficient UM system data entry.

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.

Responsibilities

• Coordinate cases for precertification and prior authorization review.
• Manage incoming calls and post services claims work.
• Determine contract and benefit eligibility; provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
• Refer cases requiring clinical review to a Nurse reviewer.
• Identify and enter referral requests into the UM system.
• 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.
• Develop and maintain positive customer relations and coordinate with various functions to handle requests.

Skills

Customer service

Communication

Multi-tasking

Empathy

Problem solving

Attention to detail

Education

HS diploma or GED

Tools

UM system

Job description

Elevance Health is seeking an Utilization Management Representative I to handle precertification, prior authorization and post-service requests. The role is virtual, with in-person training and possible office involvement within commuting distance as per policy.

Key duties include coordinating cases, reviewing contracts and benefits, authorizing initial treatment sessions, and assisting providers and clients while maintaining strong customer relations and efficient UM system data entry.