Remote Utilization Management Representative I

Elevance Health; Boght Corners (NY); Remote; USD 23,000 - 38,000; Full time

Benefits offered by this job

Comprehensive benefits package

Job summary

Elevance Health is seeking an Utilization Management Representative I to support virtual operations with in-person training as needed. The role handles calls, reviews medical needs, and coordinates with providers to ensure appropriate care and benefits are authorized.

The position requires HS diploma or GED and at least 1 year of customer service experience. Location flexibility includes multiple states, with compensation discussed in the posting.

Qualifications

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

Responsibilities

• Handle incoming calls and post service work.
• Determine contract and benefit eligibility.
• Approve inpatient admission, precertification, prior authorization, and post-service requests.
• Refer cases to Nurse reviewer for clinical review.
• Respond to inquiries from clients, providers and internal teams.
• Conduct clinical screening and authorize initial provider sessions.

Skills

Customer service

Communication

Medical terminology

Problem-solving

Education

HS diploma or GED

Tools

UM system

Job description

Elevance Health is seeking an Utilization Management Representative I to support virtual operations with in-person training as needed. The role handles calls, reviews medical needs, and coordinates with providers to ensure appropriate care and benefits are authorized.

The position requires HS diploma or GED and at least 1 year of customer service experience. Location flexibility includes multiple states, with compensation discussed in the posting.