Remote Utilization Management Rep II

Elevance Health; City of Pewaukee (WI); Hybrid; USD 52,000 - 72,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative II in Wisconsin. The role supports hybrid/virtual work with required in-person training and commuting to our Waukesha office.

You will manage calls, verify eligibility, and authorize hospital admissions and precertifications while coordinating with providers and internal teams. Candidates should have a high school diploma and healthcare customer service experience; a Master’s degree is preferred for advanced roles.

Qualifications

• Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background.

Responsibilities

• Manages incoming calls; triage, opens cases and authorizes sessions.
• Obtains intake information and performs radius search in Provider Finder; follows up with provider referrals.
• References cases requiring clinical review to a nurse reviewer; handles referrals for specialty care.
• Processes requests for precertification and/or prior authorization; screens for basic and complex needs.

Skills

Customer service

Healthcare terminology

Communication skills

Education

High School Diploma

Master's degree (preferred)

Job description

Elevance Health is seeking an Utilization Management Representative II in Wisconsin. The role supports hybrid/virtual work with required in-person training and commuting to our Waukesha office.

You will manage calls, verify eligibility, and authorize hospital admissions and precertifications while coordinating with providers and internal teams. Candidates should have a high school diploma and healthcare customer service experience; a Master’s degree is preferred for advanced roles.