Remote Utilization Management Specialist

Elevance Health; Tampa (FL); Hybrid; USD 25,000 - 34,000; Part time

Job summary

Elevation Health? Elevance Health is seeking candidates for a contract role focused on precertification coordination and claims work. The position requires organizing cases, determining eligibility, and providing timely authorizations.

You will interact with clients, providers, and internal teams in a home-based setting within a hybrid work model. Applicants should have a HS diploma or GED with at least 1 year in customer service, plus knowledge of medical terminology.

Qualifications

• HS diploma or GED with 1 year of customer service or call-center experience
• Medical terminology training and experience in medical or insurance field preferred
• Strong oral, written and interpersonal communication skills, problem-solving, facilitation, and analytical skills

Responsibilities

• Coordinate cases for precertification and prior authorization review
• Manage incoming calls and post services claims work
• Determine contract and benefit eligibility; authorize inpatient admission, outpatient precertification, prior authorization, and post service requests
• Refer cases requiring clinical review to a Nurse reviewer
• Identify and data-entry referral requests into the UM system per plan certificate
• Respond to inquiries from clients, providers and in-house departments
• Conduct clinical screening
• Authorize initial set of sessions to provider
• Check benefits for facility-based treatment
• Develop and maintain positive customer relations and coordinate with functions within the company

Skills

Customer service

Communication

Problem-solving

Facilitation

Analytical skills

Education

High school diploma or GED

Job description

Elevation Health? Elevance Health is seeking candidates for a contract role focused on precertification coordination and claims work. The position requires organizing cases, determining eligibility, and providing timely authorizations.

You will interact with clients, providers, and internal teams in a home-based setting within a hybrid work model. Applicants should have a HS diploma or GED with at least 1 year in customer service, plus knowledge of medical terminology.