Remote Utilization Management Rep I Flexible Hours

Elevance Health; United States; Remote; USD 42,000 - 54,000; Full time

Job summary

Elevance Health is seeking a Utilization Management Representative I in a virtual capacity, with in-person training as required. The role coordinates precertification and prior authorization reviews, handles calls and claims work, and collaborates with Nurse reviewers to ensure timely, accurate decisions for member care.

Ideal candidates will have at least a HS diploma or GED and 1 year of customer service experience, with strong communication, empathy, and multitasking abilities for a

Qualifications

• HS diploma or GED required.
• 1 year of customer service or call-center experience or equivalent background.

Responsibilities

• Manage incoming calls and post-service claims work.
• Determine contract and benefit eligibility and authorize inpatient/outpatient precertification, prior authorization, and post-service requests.
• Refer cases needing clinical review to a Nurse reviewer.
• Enter referral data into the UM system per plan certificate.
• Respond to inquiries from clients, providers, and in-house departments.
• Conduct clinical screening and authorize initial provider sessions.
• Verify benefits for facility-based treatment.
• Maintain positive customer relations and coordinate across functions.

Skills

Customer service

Communication

Multitasking

Empathy

Problem-solving

Attention to detail

Education

HS diploma or GED

Tools

UM system

Job description

Elevance Health is seeking a Utilization Management Representative I in a virtual capacity, with in-person training as required. The role coordinates precertification and prior authorization reviews, handles calls and claims work, and collaborates with Nurse reviewers to ensure timely, accurate decisions for member care.

Ideal candidates will have at least a HS diploma or GED and 1 year of customer service experience, with strong communication, empathy, and multitasking abilities for a