Remote Utilization Management Specialist II

Elevance Health (Anthem); Mason (OH); Hybrid; USD 55,000 - 70,000; Full time

Benefits offered by this job

Merit increases

Paid time off

Medical

Dental

Vision

401(k) + match

Stock purchase plan

Life insurance

Wellness programs

Job summary

Elevance Health is seeking an Utilization Management Representative II to handle incoming calls, triage cases, and authorize sessions across inpatient, outpatient, and post-service requests.

You will collect demographic data, verify benefits, and coordinate with nurse reviewers on referrals for specialty care. The role supports hybrid/virtual work with in-person onboarding requirements and cross-functional collaboration.

Qualifications

• Requires high school diploma or equivalent and a minimum of 2 years customer service experience in a healthcare related setting.
• Medial terminology training or background is preferred.
• Strong communication and problem-solving skills required.

Responsibilities

• Manage incoming calls and triage patient inquiries.
• Determine contract and benefit eligibility; authorize inpatient admissions, outpatient precertification, prior authorization, and post-service requests.
• Obtain demographic information from callers.
• Conduct neighborhood radius searches in Provider Finder and follow up with providers on referrals.
• Refer cases requiring clinical review to nurse reviewer; handle referrals for specialty care.
• Process requests and collect information needed for review from providers, using scripts to screen basic and complex requests for precertification and/or prior authorization.
• Verify benefits and/or eligibility information.
• Act as liaison between Medical Management and internal departments as needed.
• Respond to telephone and written inquiries from clients, providers and in-house departments.
• Conduct clinical screening process.

Skills

Customer service

Healthcare terminology

MS Excel

Education

High school diploma or equivalent

Tools

Excel

Job description

Elevance Health is seeking an Utilization Management Representative II to handle incoming calls, triage cases, and authorize sessions across inpatient, outpatient, and post-service requests.

You will collect demographic data, verify benefits, and coordinate with nurse reviewers on referrals for specialty care. The role supports hybrid/virtual work with in-person onboarding requirements and cross-functional collaboration.