Remote Utilization Management Rep II | Health Plan Support

The Elevance Health Companies, Inc.; City of Pewaukee (WI); Hybrid; USD 52,000 - 68,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) match

Stock purchase plan

Life insurance

Job summary

Elevance Health is seeking an Utilization Management Rep II to manage calls, verify eligibility, and authorize care within a hybrid-Wisconsin framework. The role supports in-person onboarding and requires at least a high school diploma with healthcare experience.

Responsibilities include collecting information, routing cases to nurse reviewers, and handling precertification requests with strong customer service skills.

Qualifications

• Strong oral, written and interpersonal communication skills.
• Problem-solving and analytical abilities.
• Healthcare terminology understanding.

Responsibilities

• Manage incoming calls and post services claims, determine eligibility and authorize inpatient or outpatient services.
• Obtain demographic information from callers and perform radius checks in Provider Finder.
• Refer cases to nurse reviewers and handle referrals for specialty care.
• Process requests for precertification and prior authorization, collecting necessary information from providers.

Skills

Oral communication

Written communication

Interpersonal skills

Problem-solving

Analytical skills

Education

HS diploma or equivalent

Job description

Elevance Health is seeking an Utilization Management Rep II to manage calls, verify eligibility, and authorize care within a hybrid-Wisconsin framework. The role supports in-person onboarding and requires at least a high school diploma with healthcare experience.

Responsibilities include collecting information, routing cases to nurse reviewers, and handling precertification requests with strong customer service skills.