Virtual Utilization Management Rep II

Elevance Health; Rocky Hill (CT); Hybrid; USD 60,000 - 80,000; Full time

Job summary

Elevance Health is seeking a Utilization Management Rep II/Clinical Liaison to support care coordination and prior authorizations. The role involves handling calls, validating benefits, and coordinating with nursing reviewers to expedite patient care.

The position offers virtual work with required in-person training sessions, and occasional office visits may be required depending on location. The candidate should have healthcare customer service experience and strong communication skills.

Qualifications

• Requires HS diploma or equivalent and 2+ years of healthcare customer service.
• Experience with medical terminology.
• Strong oral and written communication skills.
• Ability to collect demographic information and verify benefits.

Responsibilities

• Handle inbound calls and triage for utilization management.
• Authorize inpatient/outpatient requests and prior authorization.
• Gather patient and provider information and perform referrals to nurse reviewers.
• Coordinate with internal departments as needed and provide status updates.
• Document and screen requests using standard scripts.

Skills

Customer service

Healthcare experience

Medical terminology

Communication

Analytical skills

Education

HS diploma

Job description

Elevance Health is seeking a Utilization Management Rep II/Clinical Liaison to support care coordination and prior authorizations. The role involves handling calls, validating benefits, and coordinating with nursing reviewers to expedite patient care.

The position offers virtual work with required in-person training sessions, and occasional office visits may be required depending on location. The candidate should have healthcare customer service experience and strong communication skills.