Remote Utilization Management Specialist I

Elevance Health; Meridian (ID); Hybrid; USD 38,000 - 52,000; Full time

Job summary

Elevance Health is seeking a hands-on Utilization Management Representative I to coordinate precertification and prior authorization for members. This role supports flexibility with virtual work and required in-person training, while aligning with a hybrid work strategy.

You will handle calls and referrals, ensuring accurate data entry and timely responses. Ideal candidates have HS diplomas or GEDs and customer service experience, with medical terminology training preferred.

Qualifications

• Requires HS diploma or GED and 1 year of customer service or call-center experience.
• Medical terminology training and experience in medical or insurance field preferred.
• Strong verbal and written communication, plus interpersonal skills.

Responsibilities

• Managing incoming calls or incoming post services claims work.
• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
• Refers cases requiring clinical review to a Nurse reviewer.
• Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
• Responds to telephone and written inquiries from clients, providers and in-house departments.
• Conducts clinical screening process.
• Authorizes initial set of sessions to provider.
• Checks benefits for facility based treatment.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
• Associates in this role are expected to multi-task across calls, texts, facsimiles, and electronic queues while taking notes and speaking to customers.
• Performs other duties as assigned.

Skills

Call center experience

Medical terminology

Communication skills

Interpersonal skills

Education

HS diploma or GED

Job description

Elevance Health is seeking a hands-on Utilization Management Representative I to coordinate precertification and prior authorization for members. This role supports flexibility with virtual work and required in-person training, while aligning with a hybrid work strategy.

You will handle calls and referrals, ensuring accurate data entry and timely responses. Ideal candidates have HS diplomas or GEDs and customer service experience, with medical terminology training preferred.