Utilization Management Representative III (Columbus, GA)

The Elevance Health Companies, Inc.; Columbus (GA); Remote; USD 42,000 - 65,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical

Dental

Vision

Disability benefits

401(k) + match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Job summary

Elevance Health seeks an Utilization Management Representative III in Columbus, GA. The role focuses on coordinating precertification and prior authorization reviews, while guiding UM Reps and handling escalations with emphasis on customer service in a healthcare setting.

The position supports a remote-first arrangement with in-person training, offering flexibility and opportunities to contribute to process improvements and team training as needed.

Qualifications

• 3+ years of customer service experience in healthcare setting or equivalent background.
• Understanding of health plans, precertification and prior authorization processes desired.
• Strong verbal and written communication; ability to multitask in a fast-paced environment.

Responsibilities

• Coordinate cases for precertification and prior authorization review.
• Provide guidance to UM Reps on contract and benefit eligibility.
• Resolve escalated calls and direct reps to appropriate resources.
• Explain workflows, processes and priorities to the team.
• Assist in new-hire training and act as proxy for Ops Expert.

Skills

Customer service

Healthcare knowledge

Prior authorizations

Communication skills

Contracts knowledge

Education

HS diploma or GED

Job description

Job Title and Location

Utilization Management Representative III (Columbus, GA)

Job Type / Work Arrangement

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.

Job Description

The Utilization Management Representative III is responsible for coordinating cases for precertification and prior authorization review.

Responsibilities

• 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.
• 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.

Job Details

• Anticipated End Date: 2026-10-16
• Position Title: Utilization Management Representative III (Columbus, GA)
• Job Level: Non-Management Non-Exempt
• Workshift: Job Family: CUS > Care Support

Benefits

• 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
• to name a few

Vaccination Policy

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 Employment 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.

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.

Screening Requirements

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

Contact / Agency Note

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.

Additional Policies

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