Remote Utilization Management Rep II: Precert & PA

Elevance Health, Inc.; Tampa, Miami (FL, FL); Hybrid; USD 52,000 - 75,000; Full time

Job summary

Elevance Health, Inc. seeks an Utilization Management Representative II in Florida to manage incoming calls, triage cases, open files, and authorize sessions. This role supports clinical review processes and collaborates with nurses and providers.

The position is hybrid with virtual work and required in-person training. Candidates must reside in Lake Mary, Tampa or Miami, have a HS diploma and 2 years of healthcare customer service experience; medical terminology is preferred.

Qualifications

• Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training.
• URAC areas may require a Master’s degree.
• Background in healthcare or insurance fields is preferred.

Responsibilities

• Manage incoming calls and triage cases.
• Open cases and authorize sessions.
• Determine contract and benefit eligibility; provide authorization for inpatient admission, outpatient precertification, prior authorization, and post‑service requests.
• Obtain intake information from caller.
• Conduct radius search 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 and collect information needed for review from providers, using scripts to screen basic and complex requests for precertification 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 in-house departments.
• Conduct clinical screening process.

Skills

Customer service

Communication skills

Interpersonal skills

Problem-solving

Analytical skills

Medical terminology

Education

HS diploma or equivalent

Master's degree preferred

Job description

Elevance Health, Inc. seeks an Utilization Management Representative II in Florida to manage incoming calls, triage cases, open files, and authorize sessions. This role supports clinical review processes and collaborates with nurses and providers.

The position is hybrid with virtual work and required in-person training. Candidates must reside in Lake Mary, Tampa or Miami, have a HS diploma and 2 years of healthcare customer service experience; medical terminology is preferred.