Utilization Management Representative I

The Elevance Health Companies, Inc.; Columbus (OH); Teletrabalho; USD 22 000 - 33 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Comprehensive benefits package

401k contribution

Paid holidays

Paid Time Off

Medical coverage

Dental coverage

Vision coverage

Wellness programs

Resumo da oferta

Elevance Health seeks an Utilization Management Representative I to support precertification and prior authorization reviews. The role offers flexible virtual work with required in-person training and occasional office presence, located in Columbus, OH.

Key duties include handling calls, processing referrals, and ensuring timely responses while maintaining high accuracy. A valid HS diploma and at least one year in customer service are preferred.

Qualificações

• Minimum 1 year of customer service or call-center experience.
• Strong verbal and written communication skills.
• Empathy, problem-solving and attention to detail.

Responsabilidades

• Manage incoming calls and post services claims work.
• Determine contract and benefit eligibility; authorize in/outpatient requests.
• Refer cases needing clinical review to a Nurse reviewer.
• Enter referral data into the UM system accurately.
• Respond to inquiries from clients, providers and internal teams.
• Perform clinical screening and authorize initial sessions.
• Maintain positive customer relations and coordinate with functions.

Conhecimentos

Customer service

Communication

Multitasking

Empathy

Detail oriented

Formação académica

HS diploma or GED

Descrição da oferta de emprego

Utilization Management Representative I

Anticipated End Date: 2026-11-02

Virtual: This role enables associates to work virtually full-time, with the exception of 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. Alternate locations may be considered if candidates reside within a commuting distance from an office. 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 an accommodation is granted as required by law. The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review.

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.
• Refers cases requiring clinical review to a Nurse reviewer.
• Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
• Responds to telephone and written inquiries from clients, providers and in-house departments.
• Conducts clinical screening process.
• Authorizes initial set of sessions to provider.
• Checks benefits for facility based treatment.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
• Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
• Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment.
• Strong verbal and written communication skills, both with virtual and in-person interactions.
• Attentive to details, critical thinker, and a problem-solver.
• Demonstrates empathy and persistence to resolve caller issues completely.
• Comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.
• Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.
• Performs other duties as assigned.

Minimum Requirements

• HS diploma or GED.
• Minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences

• Medical terminology training and experience in medical or insurance field preferred.
• 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.

Salary & Locations

Salary range: $15.96/hr to $23.94/hr. Locations: Columbus, OH, Virginia.

Benefits

• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution
• merit increases
• paid holidays
• Paid Time Off
• 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
• financial education resources

Job Level & Family

Job Level: Non-Management. Workshift: . Job Family: CUS > Care Support.

Equal Employment Opportunity Statement

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.

Accommodations

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.