Remote Utilization Management Specialist I

The Elevance Health Companies, Inc.; Miami (FL); Hybrid; USD 25,000 - 39,000; Full time

Benefits offered by this job

Hybrid work environment

In-person training sessions

Job summary

Elevance Health is seeking an Utilization Management Representative I based in Florida. The role supports pre-certification, authorizations, and case review across inbound calls and post-service requests.

You will enter referral data in the UM system and coordinate with care teams to resolve inquiries. The position requires a HS diploma or GED and at least 1 year of customer service or call-center experience.

Qualifications

• Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience.

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.
• Authorizes initial set of sessions to provider and 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.

Skills

Customer service

Communication

Education

HS diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I based in Florida. The role supports pre-certification, authorizations, and case review across inbound calls and post-service requests.

You will enter referral data in the UM system and coordinate with care teams to resolve inquiries. The position requires a HS diploma or GED and at least 1 year of customer service or call-center experience.