Remote Utilization Management Rep II - Authorization

Elevance Health; Waukesha (WI); Hybrid; USD 42,000 - 62,000; Full time

Job summary

Elevance Health in Wisconsin is seeking an Utilization Management Representative II to handle inbound calls, triage cases, and obtain authorizations. This role emphasizes accuracy in collecting information, verifying benefits, and coordinating with nurses for complex cases.

The position requires a high school diploma and 2+ years in healthcare customer service, with strong communication and analytical skills. Hybrid work with in-person training sessions supports career growth and compliance.

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.
• Strong oral, written and interpersonal communication skills as part of URAC accredited areas.
• May require Master's in certain contracts.

Responsibilities

• Manage incoming calls and triage using established protocols to determine eligibility and necessary authorizations.
• Obtain demographic information from callers and follow up with providers on referrals.
• Refer complex cases to nurse reviewers and coordinate specialty referrals.
• Process requests for precertification and prior authorization, collecting information needed for review.
• Verify benefits and eligibility information for members.
• Act as liaison between Medical Management and internal departments as needed.
• Respond to questions from clients, providers and internal teams.
• Participate in clinical screening processes as required.

Skills

Customer service

Communication skills

Healthcare terminology

Call triage

Education

High school diploma

Tools

Provider Finder

Job description

Elevance Health in Wisconsin is seeking an Utilization Management Representative II to handle inbound calls, triage cases, and obtain authorizations. This role emphasizes accuracy in collecting information, verifying benefits, and coordinating with nurses for complex cases.

The position requires a high school diploma and 2+ years in healthcare customer service, with strong communication and analytical skills. Hybrid work with in-person training sessions supports career growth and compliance.