Remote Utilization Management Specialist I

Elevance Health, Inc.; Oregon; Hybrid; USD 23,000 - 38,000; Full time

Benefits offered by this job

Benefits package

Equity stock purchase plan

401(k) plan

Job summary

Elevance Health, Inc. is hiring a Utilization Management Representative I for a virtual, full-time role with required in-person training sessions.

The position coordinates cases for precertification and prior authorization reviews and requires a HS diploma or GED with at least 1 year of customer service or call-center experience. The role involves managing calls, verifying eligibility, authorizing services, and coordinating with Nurse reviewers and internal teams.

Qualifications

• Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience.
• Education or experience equivalent background may be considered.

Responsibilities

• Manage incoming calls and post services claims.
• Determine contract and benefit eligibility.
• Authorize inpatient and outpatient precertification and prior authorizations.
• Refer cases requiring clinical review to a Nurse reviewer.
• Identify and enter referral requests into the UM system.
• Respond to inquiries from clients, providers and internal teams.
• Demonstrate strong verbal and written communication skills in virtual and in-person interactions.

Skills

Customer service

Call center

Education

High School Diploma or GED

Job description

Elevance Health, Inc. is hiring a Utilization Management Representative I for a virtual, full-time role with required in-person training sessions.

The position coordinates cases for precertification and prior authorization reviews and requires a HS diploma or GED with at least 1 year of customer service or call-center experience. The role involves managing calls, verifying eligibility, authorizing services, and coordinating with Nurse reviewers and internal teams.