Utilization Management Specialist II — Hybrid

The Elevance Health Companies, Inc.; San Antonio (TX); Hybrid; USD 42,000 - 64,000; Full time

Job summary

BioPlus Specialty Pharmacy, a member of the Elevance Health family, seeks an Utilization Management Representative II to manage incoming calls, triage cases, and authorize sessions. This role supports clinical decision processes and works with providers to verify benefits and eligibility.

The position emphasizes accurate data collection, coverage determinations, and liaison duties across Medical Management and other departments. A healthcare-focused, customer-service mindset is essential.

Qualifications

• HS diploma or equivalent.
• Minimum 2 years of customer service experience in a healthcare setting with medical terminology training.

Responsibilities

• Manage incoming calls and triage healthcare requests.
• Determine contract and benefit eligibility; authorize inpatient/outpatient services and precertification.
• Obtain demographic information from callers and gather needed documentation.
• Refer cases for clinical review when needed and handle referrals for specialty care.
• Verify benefits/eligibility and coordinate with internal departments.

Skills

Prior authorization

Precertification

Communication

Analytical skills

Education

HS diploma

Job description

BioPlus Specialty Pharmacy, a member of the Elevance Health family, seeks an Utilization Management Representative II to manage incoming calls, triage cases, and authorize sessions. This role supports clinical decision processes and works with providers to verify benefits and eligibility.

The position emphasizes accurate data collection, coverage determinations, and liaison duties across Medical Management and other departments. A healthcare-focused, customer-service mindset is essential.