Remote Utilization Management Representative I

Elevance Health, Inc.; Atlanta (GA); Hybrid; USD 22,000 - 33,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews. The role supports virtual full-time work with occasional in-person training and requires strong communication with clients, providers and internal teams.

The position involves handling calls, data entry, clinical screening, and workflow multitasking in a fast-paced environment. Hybrid/virtual options are available and location-based salary applies.

Qualifications

• HS diploma or GED required.
• Minimum of 1 year of customer service or call-center experience or equivalent background.

Responsibilities

• Coordinate cases for precertification and prior authorization review.
• Handle incoming calls and post services claims work.
• Determine contract and benefit eligibility; provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
• Refer cases requiring clinical review to a Nurse reviewer.
• Identify and data-enter referral requests into the UM system per plan certificate.
• Respond to inquiries from clients, providers and internal departments.
• Conduct clinical screening and authorize initial set of sessions to providers.
• Check benefits for facility-based treatment.
• Maintain positive customer relations and coordinate with other functions to address requests promptly.
• Demonstrate multi-tasking across calls, texts, faxes, and electronic queues.

Skills

Medical terminology

Customer service

Education

HS diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews. The role supports virtual full-time work with occasional in-person training and requires strong communication with clients, providers and internal teams.

The position involves handling calls, data entry, clinical screening, and workflow multitasking in a fast-paced environment. Hybrid/virtual options are available and location-based salary applies.