Virtual Utilization Management Associate I

Elevance Health; Columbus (OH); Remote; USD 22,000 - 33,000; Full time

Job summary

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization review. The role involves handling calls and post-service claims, determining eligibility, and authorizing initial treatment sessions.

You will refer cases for clinical review and maintain strong customer relations in a fast-paced environment. The position supports virtual/hybrid work arrangements with in-person training, and is located in Columbus, OH or other

Qualifications

• HS diploma or GED required.
• Minimum of 1 year of customer service or call-centre experience.
• Medical terminology training and experience in medical or insurance field preferred.

Responsibilities

• Coordinate cases for precertification and prior authorization review.
• Manage incoming calls and 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 input referral requests into the UM system.
• Respond to inquiries from clients, providers and in-house departments.
• Conduct clinical screening process and authorize initial set of sessions.
• Check benefits for facility-based treatment.
• Maintain positive customer relations and coordinate with various functions.

Skills

Customer service

Communication

Multitasking

Problem-solving

Empathy

Education

High school diploma or GED

Job description

Elevance Health is seeking an Utilization Management Representative I to coordinate precertification and prior authorization review. The role involves handling calls and post-service claims, determining eligibility, and authorizing initial treatment sessions.

You will refer cases for clinical review and maintain strong customer relations in a fast-paced environment. The position supports virtual/hybrid work arrangements with in-person training, and is located in Columbus, OH or other