Remote Utilization Management Rep II

Elevance Health

Kentucky

Hybrid

USD 42,000 - 54,000

Full time

8 days ago

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Job summary

Elevance Health is seeking an Utilization Management Representative II to support a hybrid work model with a mix of virtual work and required in-person training. The role centers on triage, case opening, and authorizations, aligning with our patient-first philosophy.

The ideal candidate will have at least a HS diploma and 2 years of healthcare customer service experience, with solid Excel skills and proficiency in medical terminology. Join a Fortune 25 company focused on whole-health outcomes.

Qualifications

Requires HS diploma or equivalent and a minimum of 2 years customer service experience in a healthcare-related setting.
Experience with medical terminology training is preferred.
Intermediate Excel experience is strongly preferred.

Responsibilities

Manage incoming calls and triage requests, including opening of cases and authorizing sessions.
Determine contract and benefit eligibility; provide authorization for inpatient admission, outpatient precertification, prior authorization, and post-service requests.
Obtain intake information (demographics) from callers.
Conduct radius searches in Provider Finder and follow up with providers on referrals.
Refer cases requiring clinical review to a nurse reviewer; handle referrals for specialty care.
Process incoming requests, gather information needed for review from providers, and screen requests for pre-certification and/or prior authorization.
Verify benefits and/or eligibility information.
Act as liaison between Medical Management and internal departments.
Respond to telephone and written inquiries from clients, providers, and internal teams.
Conduct clinical screening processes.