Utilization Management Specialist I - Remote

Elevance Health; Boght Corners (NY); Remote; USD 23,000 - 38,000; Full time

Job summary

Elevance Health in the United States is hiring a Utilization Management Representative I (US) for a virtual role. The position handles calls and post services, determines eligibility, and authorizes care across inpatient and outpatient settings.

Candidates should have a HS diploma or GED and at least 1 year in customer service, with medical/insurance knowledge. The role offers hybrid/remote flexibility with occasional in-person training and requires ability to manage multiple tasks in a

Qualifications

• Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
• Medical terminology training.
• Experience in a medical or insurance field.
• For URAC accredited areas, strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Responsibilities

• Manage incoming calls or incoming post services claims work.
• Determine contract and benefit eligibility.
• Provide authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
• Refer cases requiring clinical review to a Nurse reviewer.
• Identify and enter referral requests into the UM system in accordance with the plan certificate.
• Respond to telephone and written inquiries from clients, providers and in-house departments.
• Conduct clinical screening process.
• Authorize initial set of sessions to provider.
• Check benefits for facility based treatment.
• Develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

Skills

Medical terminology training

Insurance field experience

Communication skills (URAC context)

Job description

Elevance Health in the United States is hiring a Utilization Management Representative I (US) for a virtual role. The position handles calls and post services, determines eligibility, and authorizes care across inpatient and outpatient settings.

Candidates should have a HS diploma or GED and at least 1 year in customer service, with medical/insurance knowledge. The role offers hybrid/remote flexibility with occasional in-person training and requires ability to manage multiple tasks in a