Remote Utilization Management Specialist II

The Elevance Health Companies, Inc.; Tampa (FL); Hybrid; USD 42,000 - 62,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative II in Florida. The role involves managing inbound calls, triage, case openings, and authorizations for inpatient and outpatient services.

Candidates must reside in Lake Mary, Tampa, or Miami, FL and be available to work 4 days per week 12 pm–9 pm EST with one weekend day, plus occasional in-person training. Hybrid/virtual work is supported with required onsite sessions.

Qualifications

• Requires HS diploma or equivalent and 2+ years of healthcare customer service experience.
• Medical terminology training is preferred but not required.
• Equivalent combination of education and experience may apply.

Responsibilities

• Handle incoming calls, triage, open cases and authorize sessions.
• Determine contract and benefit eligibility; provide authorization for inpatient/outpatient services.
• Obtain caller demographics; verify benefits and eligibility.
• Conduct provider searches and coordinate referrals with nurses.
• Screen requests for precertification and prior authorization using scripts.
• Serve as liaison between Medical Management and internal departments.

Skills

Communication skills

Problem-solving

Analytical skills

Interpersonal skills

Adaptability

Education

High school diploma or equivalent

Job description

Elevance Health is seeking an Utilization Management Representative II in Florida. The role involves managing inbound calls, triage, case openings, and authorizations for inpatient and outpatient services.

Candidates must reside in Lake Mary, Tampa, or Miami, FL and be available to work 4 days per week 12 pm–9 pm EST with one weekend day, plus occasional in-person training. Hybrid/virtual work is supported with required onsite sessions.