Remote Utilization Management Rep I Precert & Authorization

Elevance Health; Columbus (OH); Hybrid; USD 22,000 - 33,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews. This virtual role offers flexibility with occasional in-person training and a hybrid option depending on location.

You will handle calls and referrals, determine eligibility, authorize services, and collaborate with nurses and other teams to ensure timely, accurate decisions for members with complex needs. Strong communication and multitasking are required.

Qualifications

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

Responsibilities

• Manage incoming calls and post services claims work.
• Determine eligibility and authorize inpatient/outpatient services.
• Refer cases to a Nurse reviewer when clinical review is needed.
• Enter referral requests into the UM system.
• Provide responsive service to clients, providers, and internal teams.
• Handle multiple tasks in a fast-paced environment.

Skills

Customer service

Communication

Multitasking

Education

High School Diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews. This virtual role offers flexibility with occasional in-person training and a hybrid option depending on location.

You will handle calls and referrals, determine eligibility, authorize services, and collaborate with nurses and other teams to ensure timely, accurate decisions for members with complex needs. Strong communication and multitasking are required.