Remote Utilization Specialist I

Elevance Health; Cincinnati (OH); Remote; USD 42,000 - 62,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Elevance Health is seeking an Utilization Management Representative I for a virtual, full-time role with optional in-person training. The position coordinates cases for precertification and prior authorization review, handling calls and referrals while ensuring eligibility checks and timely responses.

The role requires strong communication skills, attention to detail, and the ability to multitask in a fast-paced environment. A hybrid/remote work policy applies with occasional onsite requirements.

Qualifications

• HS diploma or GED required.
• At least 1 year of customer service or call-center experience.
• Medical terminology training or experience in medical/insurance field preferred.
• URAC competencies: strong oral, written and interpersonal communication, problem-solving, facilitation and analytical skills.

Responsibilities

• Manage incoming calls and post-service claims work.
• Determine contract and benefit eligibility; authorize inpatient admission, precertification, prior authorization, and post-service requests.
• Refer cases requiring clinical review to a Nurse reviewer.
• Enter referral requests into the UM system in accordance with plan certificate.
• Respond to inquiries from clients, providers and internal departments.
• Perform clinical screening and authorize initial sessions to providers.
• Check benefits for facility-based treatment.
• Maintain positive customer relations and coordinate with functions across the company.
• Multitask across calls, texts, faxes and electronic queues while taking notes.

Skills

Customer service

Communication

Medical terminology

Education

HS diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I for a virtual, full-time role with optional in-person training. The position coordinates cases for precertification and prior authorization review, handling calls and referrals while ensuring eligibility checks and timely responses.

The role requires strong communication skills, attention to detail, and the ability to multitask in a fast-paced environment. A hybrid/remote work policy applies with occasional onsite requirements.