Remote Utilization Management Rep I: Precert & Auth

Elevance Health, Inc.; Oregon; Hybrid; USD 42,000 - 64,000; Full time

Job summary

Elevance Health, Inc. is seeking a Utilization Management Representative I for remote work, with in-person training as needed. The role supports precertification, prior authorization, and post-service review, coordinating with nursing staff for clinical input.

The position requires at least a high school diploma and 1 year in customer service, with familiarity in medical terminology and insurance processes. A flexible schedule and office optional in some locations are mentioned.

Qualifications

• HS diploma or GED required.
• Minimum 1 year of customer service or call-center experience.
• Medical terminology training or insurance experience preferred.

Responsibilities

• Manage incoming calls and post-service claims work.
• Determine contract and benefit eligibility; authorize inpatient/outpatient requests.
• Refer cases needing clinical review to a nurse reviewer.
• Enter referral requests into the UM system accurately.
• Respond to inquiries from clients, providers and internal teams.

Skills

Customer service

Medical terminology

Communication

Teamwork

Education

HS diploma or GED

Tools

UM system data entry

Job description

Elevance Health, Inc. is seeking a Utilization Management Representative I for remote work, with in-person training as needed. The role supports precertification, prior authorization, and post-service review, coordinating with nursing staff for clinical input.

The position requires at least a high school diploma and 1 year in customer service, with familiarity in medical terminology and insurance processes. A flexible schedule and office optional in some locations are mentioned.