Utilization Management Rep II (US)

Elevance Health (Anthem); City of Pewaukee (WI); Hybrid; USD 48,000 - 64,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Paid Time Off

Medical, dental, vision

401(k) + match

Stock purchase plan

Life insurance

Wellness programs

Job summary

Elevance Health, a Fortune 25 health company, seeks a Utilization Management Rep II in Wisconsin. The role supports authorization, eligibility determinations, and referrals with hybrid/virtual flexibility and essential in-person training.

Candidates should have a HS diploma and 2+ years in healthcare customer service; strong communication and analytical skills are required. Onsite collaboration at the Waukesha, WI office is expected.

Qualifications

• Requires HS diploma or equivalent and 2 years of customer service experience in a healthcare setting, plus medical terminology training.
• Strong oral and written communication skills, attention to detail, and ability to handle sensitive information.

Responsibilities

• Manage incoming calls and post services claims work.
• Determine contract and benefit eligibility; authorize inpatient admissions, precertification, prior authorization, and post-service requests.
• Obtain demographic information from callers.
• Conduct radius search in Provider Finder and follow up with providers on referrals.
• Refer cases for clinical review to a nurse reviewer; handle referrals for specialty care.
• Process requests and collect information for review to screen precertification/prior authorization.
• Verify benefits and eligibility information.
• Act as liaison between Medical Management and internal departments.
• Respond to inquiries from clients, providers and internal teams.
• Conduct clinical screening process.

Skills

Customer service

Medical terminology

Communication skills

Problem solving

Education

High School Diploma

Job description

Anticipated End Date: 2026-11-23

Position Title

Utilization Management Rep II (US)

Job Description

Utilization Management Representative II

Location

You must reside in the state of Wisconsin, within a commutable distance to our Waukesha, WI office located at N17W24222 Riverwood Drive, Suite 300, Waukesha, WI 53188.

Virtual

This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

How you will make an impact

• Managing incoming calls or incoming post services claims work
• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
• Obtains intake (demographic) information from caller
• Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given
• Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care
• Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization
• Verifies benefits and/or eligibility information
• May act as liaison between Medical Management and internal departments\
• Responds to telephone and written inquiries from clients, providers and in‑house departments
• Conducts clinical screening process

Minimum Requirements

Requires HS diploma or equivalent and a minimum of 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences

• For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
• Certain contracts require a Master's degree

Job Level

Non-Management Non-Exempt

Workshift

1st Shift (United States of America)

Job Family

CUS > Care Support

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, c