Remote Utilization Management Representative I

Elevance Health, Inc.; Mendota Heights (MN); Remote; USD 23,000 - 38,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I (US) to coordinate precertification and prior authorization reviews, supporting virtual full-time work with required in-person training sessions. Alternate locations may be considered if commuting distance is feasible.

The role involves handling calls, determining eligibility, authorizing services, and coordinating with nurse reviewers to ensure timely, accurate decisions for members and providers.

Qualifications

• HS diploma or GED with 1+ year of customer service or call-center experience.
• Experience in medical or insurance fields preferred.
• URAC accredited areas require strong communication, problem-solving, facilitation, and analytical skills.

Responsibilities

• Manage 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 to a Nurse reviewer for clinical review.
• Enter referral requests into the UM system accurately.
• Respond to inquiries from clients, providers and internal departments.

Skills

Medical terminology

Insurance experience

Communication skills

Problem solving

Interpersonal skills

Analytical skills

Job description

Elevance Health is seeking an Utilization Management Representative I (US) to coordinate precertification and prior authorization reviews, supporting virtual full-time work with required in-person training sessions. Alternate locations may be considered if commuting distance is feasible.

The role involves handling calls, determining eligibility, authorizing services, and coordinating with nurse reviewers to ensure timely, accurate decisions for members and providers.