Utilization Management Representative III (Columbus, GA)

Elevance Health; Columbus (GA); Remote; USD 52,000 - 68,000; Full time

Job summary

Elevance Health in Columbus, GA seeks an Utilization Management Representative III to coordinate precertification and prior authorization reviews for inpatient and outpatient services. This role supports a hybrid/remote work model with occasional in-person training and requires strong communication, problem-solving, and knowledge of health plans and contract terms.

You will mentor teammates, resolve escalated calls, and uphold core values daily.

Qualifications

• Minimum 3 years of customer service experience in a healthcare setting.
• Knowledge of health plans, prior authorization, and precertification processes.
• Understanding of contracts and managed care programs.

Responsibilities

• Coordinate cases for precertification and prior authorization review.
• Provide technical guidance to UM Reps handling eligibility queries.
• Assist management by identifying improvement areas and taking on new projects.
• Handle escalated calls and direct reps to appropriate resources.
• Explain workflows, guidelines, and departmental priorities clearly.
• Support new hire training and act as proxy when needed.
• Maintain focus while multitasking across calls, texts, and queues.

Skills

Customer service

Healthcare knowledge

Communication

Problem solving

Education

HS diploma or GED

Job description

Utilization Management Representative III (Columbus, GA)

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 III is responsible for coordinating cases for precertification and prior authorization review.

How you will make an impact:

• Responsible for providing technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services outside of initial authorized set.
• Assisting management by identifying areas of improvement and expressing a willingness to take on new projects as assigned.
• Handling escalated and unresolved calls from less experienced team members.
• Ensuring UM Reps are directed to the appropriate resources to resolve issues.
• Ability to understand and explain specific workflow, processes, departmental priorities and guidelines.
• May assist in new hire training to act as eventual proxy for Ops Expert.
• Exemplifies behaviors embodied in the 5 Core Values.
• 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 3 years of experience in customer service experience in healthcare related setting; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences

• Knowledge of health plans, including familiarity with prior authorization and precertification process preferred.
• Knowledge of contracts and strong knowledge of managed benefit programs strongly 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.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

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.

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

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.

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