Remote Utilization Management Rep III: Precert

Elevance Health; Grand Prairie (TX); On-site; USD 52,000 - 78,000; Full time

Job summary

Elevance Health is seeking an Afterhours Utilization Management Representative III to coordinate precertification and prior authorization reviews. This remote role offers flexibility with required in-person training, and a hybrid/virtual work policy managing time zones and office time as needed.

You will guide UM Reps, resolve escalated calls, and ensure callers are directed to the right resources. Strong communication, problem solving, and healthcare terminology are essential as you support

Qualifications

• Requires a HS diploma or GED and a minimum of 3 years of experience in customer service experience in healthcare related setting; or any combination of education and experience which would provide an equivalent background.
• Medical terminology training required.

Responsibilities

• Coordinate cases for precertification and prior authorization review.
• Provide technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility.
• Assist management by identifying areas of improvement and taking on new projects as assigned.
• Handle escalated and unresolved calls from less experienced team members.
• Ensure UM Reps are directed to the appropriate resources to resolve issues.
• Explain workflows, processes, and guidelines to team members.

Skills

Customer service

Call center experience

Medical terminology

Communication skills

Empathy

Education

HS diploma or GED

Medical terminology training

Job description

Elevance Health is seeking an Afterhours Utilization Management Representative III to coordinate precertification and prior authorization reviews. This remote role offers flexibility with required in-person training, and a hybrid/virtual work policy managing time zones and office time as needed.

You will guide UM Reps, resolve escalated calls, and ensure callers are directed to the right resources. Strong communication, problem solving, and healthcare terminology are essential as you support