Remote Utilization Management Specialist I

Elevance Health; Seven Fields (Butler County); Remote; USD 45,000 - 65,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews. The role is remote with occasional in-person training sessions and flexible scheduling to support work-life balance.

You will manage calls, determine eligibility, authorize initial sessions, and refer complex cases to nurses. Strong communication, empathy, and multitasking are essential in a fast-paced environment.

Qualifications

• Minimum 1 year of customer service or call-center experience.
• Medical terminology training or insurance field exposure preferred.

Responsibilities

• Coordinate cases for precertification and prior authorization reviews.
• Handle incoming calls and inquiries from clients, providers, and internal teams.
• Determine contract and benefit eligibility and authorize inpatient or outpatient services as appropriate.
• Refer cases requiring clinical review to a Nurse reviewer.
• Enter referral requests into the UM system accurately and timely.
• Maintain positive customer relations and collaborate with company functions to resolve questions.

Skills

Customer service

Communication skills

Multitasking

Empathy

Education

HS diploma or GED

Tools

UM system

Job description

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization reviews. The role is remote with occasional in-person training sessions and flexible scheduling to support work-life balance.

You will manage calls, determine eligibility, authorize initial sessions, and refer complex cases to nurses. Strong communication, empathy, and multitasking are essential in a fast-paced environment.