Remote Utilization Management Representative I

Elevance Health; United States; Hybrid; USD 25,000 - 33,000; Full time

Job summary

Elevance Health seeks a dedicated Utilization Management Representative I to support precertification and prior authorization processes in a US-based role with remote work options. The position includes in-person training and scheduled hours, with potential office involvement as needed.

You will coordinate cases, verify coverage, and process approvals while maintaining client and provider communications. Training is remote for two weeks, followed by a standard shift.

Qualifications

• Requires HS diploma or GED and at least 1 year of customer service or call-center experience.
• Preferred: medical terminology training.
• Experience in a medical or insurance field is preferred.

Responsibilities

• Manage incoming calls or post-service claims work.
• Determine contract and benefit eligibility.
• Provide authorization for 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 per plan certificate.
• Respond to inquiries from clients, providers and in-house departments.
• Conduct clinical screening processes and authorize initial sessions to providers.
• Check benefits for facility-based treatment.
• Maintain positive customer relations and coordinate across functions.
• Handle multi-tasking across calls, texts, faxes, and electronic queues while taking notes.
• Maintain focus in a fast-paced environment and communicate clearly.
• Demonstrate attention to detail, critical thinking and problem-solving.
• Demonstrate empathy to resolve caller issues completely.
• Use digital tools to enhance productivity and minimize manual work.
• Work a structured schedule with occasional overtime or on-site requirements as needed.
• Perform other duties as assigned.

Skills

Medical terminology training

Insurance field experience

Clinical communication skills

Job description

Elevance Health seeks a dedicated Utilization Management Representative I to support precertification and prior authorization processes in a US-based role with remote work options. The position includes in-person training and scheduled hours, with potential office involvement as needed.

You will coordinate cases, verify coverage, and process approvals while maintaining client and provider communications. Training is remote for two weeks, followed by a standard shift.