Remote Utilization Management Representative I

Elevance Health, Inc.; Mason (OH); Remote; USD 25,000 - 34,000; Full time

Job summary

Elevance Health, Inc. is seeking a Utilization Management Representative I (US) to coordinate cases for precertification and prior authorization review.

This remote role requires completing training remotely, with in-person sessions as needed, and offers flexibility within Mountain Time business hours. Responsibilities include managing calls, determining eligibility, approving various authorizations, and entering referrals into the UM system.

Qualifications

• Requires HS diploma or GED and 1 year of customer service or call-center experience.
• Experience in a medical or insurance field preferred.
• URAC related areas require strong oral, written and interpersonal communication, problem-solving, facilitation and analytical skills.

Responsibilities

• Manage inbound calls and post-service claims work.
• Determine contract and benefit eligibility.
• Authorize inpatient admissions, outpatient precertification, prior authorization and post-service requests.
• Refer cases requiring clinical review to a Nurse reviewer.
• Enter referral requests into the UM system.
• Respond to inquiries from clients, providers and internal teams.
• Conduct clinical screening process.
• Authorize initial sessions to providers.
• Check benefits for facility-based treatment.
• Maintain positive customer relations and coordinate with functions to handle requests promptly.
• Multi-task calls, texts, faxes and electronic queues while taking notes.

Skills

Customer service

Call center

Communication

Problem solving

Education

HS diploma or GED

Tools

UM system

Job description

Elevance Health, Inc. is seeking a Utilization Management Representative I (US) to coordinate cases for precertification and prior authorization review.

This remote role requires completing training remotely, with in-person sessions as needed, and offers flexibility within Mountain Time business hours. Responsibilities include managing calls, determining eligibility, approving various authorizations, and entering referrals into the UM system.