Utilization Management Rep II (US)

The Elevance Health Companies, Inc.; City of Pewaukee (WI); Hybrid; USD 52,000 - 68,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) match

Stock purchase plan

Life insurance

Job summary

Elevance Health is seeking an Utilization Management Rep II to manage calls, verify eligibility, and authorize care within a hybrid-Wisconsin framework. The role supports in-person onboarding and requires at least a high school diploma with healthcare experience.

Responsibilities include collecting information, routing cases to nurse reviewers, and handling precertification requests with strong customer service skills.

Qualifications

• Strong oral, written and interpersonal communication skills.
• Problem-solving and analytical abilities.
• Healthcare terminology understanding.

Responsibilities

• Manage incoming calls and post services claims, determine eligibility and authorize inpatient or outpatient services.
• Obtain demographic information from callers and perform radius checks in Provider Finder.
• Refer cases to nurse reviewers and handle referrals for specialty care.
• Process requests for precertification and prior authorization, collecting necessary information from providers.

Skills

Oral communication

Written communication

Interpersonal skills

Problem-solving

Analytical skills

Education

HS diploma or equivalent

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.

Hybrid Workforce Strategy

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.

Vaccination Requirement

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.

Equal Opportunity Employment

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Accommodation

Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

Background Check

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Florida Law Screening

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

Workday Posting Note

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.

Company History

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

Talent Community

Join our Talent Community and stay connected with company news, information, and future job opportunities.

Purpose & Vision

Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner.Our nearly 100,000 associates serve approximately 100M+ people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health.

Duplicate Equal Opportunity

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Duplicate Accommodation

Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

Duplicate Background Check

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Duplicate Florida Law Screening

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration

Contract Worker Community

Please visit the Contract Worker Community Page.

Equal Opportunity Employer / Disability / Veterans

Elevance Health is an Equal Opportunity Employer/Disability/Veterans.