Remote Utilization Management Specialist II

Elevance Health (Anthem); Tampa (FL); Remote; USD 55,000 - 75,000; Full time

Job summary

Elevance Health is seeking a skilled Utilization Management Representative II to manage calls, triage cases, and authorize inpatient and outpatient services. The role requires navigating benefit eligibility, gathering demographic information, and coordinating with providers using Provider Finder.

Strong communication and clinical screening are essential. The position supports a hybrid/remote work model with in-person training sessions as needed, in a Florida-based posting.

Qualifications

• HS diploma or equivalent with 2+ years healthcare customer service experience.
• Medical terminology training or background preferred.
• Ability to handle calls, triage, and case openings.
• Strong communication and analytical skills.

Responsibilities

• Manage incoming calls and triage cases.
• Determine eligibility and authorize inpatient/outpatient requests.
• Obtain demographic information from callers.
• Search Provider Finder and coordinate with providers.
• Refer cases for nurse review and specialty care.
• Gather information for review and precertification/prior authorization.
• Verify benefits and eligibility.
• Liaise between Medical Management and other departments.
• Respond to inquiries from clients, providers and internal teams.
• Conduct clinical screening.

Skills

Oral communication

Written communication

Interpersonal skills

Problem-solving

Facilitation

Analytical skills

Medical terminology

Education

HS diploma

Tools

Provider Finder

Job description

Elevance Health is seeking a skilled Utilization Management Representative II to manage calls, triage cases, and authorize inpatient and outpatient services. The role requires navigating benefit eligibility, gathering demographic information, and coordinating with providers using Provider Finder.

Strong communication and clinical screening are essential. The position supports a hybrid/remote work model with in-person training sessions as needed, in a Florida-based posting.