Utilization Management Specialist II — Remote

Elevance Health; Tampa (FL); Remote; USD 25,000 - 33,000; Full time

Job summary

Elevance Health is seeking a detail-oriented Utilization Management Representative II to manage inbound calls, determine eligibility, and authorize care. The role supports virtual work with required in-person training sessions and may require commuting within a reasonable distance to posting locations in Florida.

You will collect patient demographics, perform clinical screening, and liaise with medical management and other departments to ensure timely and accurate authorizations and referrals.

Qualifications

• Minimum 2 years customer service experience in a healthcare-related setting.
• Medical terminology training or equivalent background desired.

Responsibilities

• Handle incoming calls and triage patient inquiries.
• Determine contract and benefit eligibility for authorizations.
• Obtain intake information from callers and verify demographics.
• Conduct radius searches in Provider Finder and follow up with providers.
• Refer cases requiring clinical review to a nurse reviewer.
• Process requests for precertification and/or prior authorization with scripts.

Skills

Customer service

Healthcare terminology

Phone handling

Communication

Problem-solving

Detail-oriented

Education

HS diploma or equivalent

Medical terminology training

Job description

Elevance Health is seeking a detail-oriented Utilization Management Representative II to manage inbound calls, determine eligibility, and authorize care. The role supports virtual work with required in-person training sessions and may require commuting within a reasonable distance to posting locations in Florida.

You will collect patient demographics, perform clinical screening, and liaise with medical management and other departments to ensure timely and accurate authorizations and referrals.