Remote Utilization Management Rep I (FL) Healthcare Access

Elevance Health, Inc.; Miami, Tampa (FL, FL); Hybrid; USD 25,000 - 30,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I to support precertification and prior authorization review from within Florida. The role involves handling calls, reviewing benefits, and ensuring accurate data entry while delivering empathetic service to providers and members.

Ideal candidates will reside in Lake Mary, Tampa, or Miami and bring strong customer service experience. This position supports a hybrid/remote work model with required in-person training sessions and

Qualifications

• Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience.
• Preferred: medical terminology training and Medicaid utilization management experience.

Responsibilities

• Manage incoming calls and 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.
• Authorizes initial set of sessions to provider and checks benefits for facility based treatment.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests 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.

Skills

Customer service

Call center

Education

HS diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I to support precertification and prior authorization review from within Florida. The role involves handling calls, reviewing benefits, and ensuring accurate data entry while delivering empathetic service to providers and members.

Ideal candidates will reside in Lake Mary, Tampa, or Miami and bring strong customer service experience. This position supports a hybrid/remote work model with required in-person training sessions and