Utilization Management Representative I (Tampa, FL)

Elevance Health; Tampa (FL); Remote; USD 35,000 - 45,000; Full time

Job summary

A healthcare company is seeking a Utilization Management Representative I to manage precertification and prior authorization cases virtually. This role requires strong customer service skills and a high school diploma or GED. The ideal candidate will have at least one year of experience in a call center environment. Join us to make a meaningful impact while enjoying the flexibility of remote work.

Qualifications

• Minimum of 1 year of customer service or call-center experience.
• Medical terminology training preferred.

Responsibilities

• Manage incoming calls or claims work.
• Provide authorization for inpatient admission and outpatient precertification.
• Coordinate with various functions within the company.

Skills

Customer service experience

Communication skills

Attention to detail

Education

HS diploma or GED

Job description

Utilization Management Representative I

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.

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 will be 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.

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.
• Customer Service and Prior Authorization experience preferred.

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.