Remote Utilization Management Specialist I

Elevance Health; Latham (NY); Hybrid; USD 23,000 - 38,000; Full time

Job summary

Elevance Health is seeking a Utilization Management Representative I (US) to coordinate cases for precertification and prior authorization review. This role emphasizes collaborative work with nurse reviewers and providers to ensure timely and accurate decisions.

In a hybrid/remote setting with in-person training as needed, you will manage calls, determine eligibility, authorize services, and maintain strong client relationships.

Qualifications

• Minimum requirements: HS diploma or GED plus 1 year of customer service or call-center experience, or equivalent background.
• Preferred: medical terminology training and insurance industry exposure.
• URAC-related areas value strong communication, problem-solving, facilitation and analytical skills.

Responsibilities

• Manage incoming calls or post services claims work.
• Determine contract and benefit eligibility.
• Provide authorization for inpatient admission, 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 certificates.
• Respond to inquiries from clients, providers, and internal departments.
• Conduct clinical screening and authorize initial set of sessions.
• Check benefits for facility-based treatment.

Skills

Medical terminology training

Insurance field experience

Oral and written communication

Interpersonal skills

Problem-solving

Analytical skills

Facilitation

Education

HS diploma or GED

Job description

Elevance Health is seeking a Utilization Management Representative I (US) to coordinate cases for precertification and prior authorization review. This role emphasizes collaborative work with nurse reviewers and providers to ensure timely and accurate decisions.

In a hybrid/remote setting with in-person training as needed, you will manage calls, determine eligibility, authorize services, and maintain strong client relationships.