Salary
Pay range: $16.31/hr – $26.81/hr. Actual pay will be based on skills and experience.
Anticipated End Date
2025-11-06
Position Title
Utilization Management Representative I – Behavioral Health Utilization Management
Location & Work Arrangement
(Virtual full-time with required in-person training sessions). Locations: California, Colorado, Nevada, Washington. Candidates must be within reasonable commuting distance unless accommodation is granted.
Hours
Shift Monday–Friday, assigned between 7:00 AM–5:00 PM Pacific.
Job Description
The UM Representative I is responsible for coordinating precertification, prior authorization and post-service reviews for government and commercial sectors.
How you will make an impact
Managing incoming calls and post services claims work.
Determining contract and benefit eligibility; providing authorizations for inpatient admission, outpatient precertification, prior authorization, and post service requests.
Referring cases requiring clinical review to a Nurse reviewer.
Identifying and entering referral requests into the UM system per plan certificate.
Responding to telephone and written inquiries from clients, providers, and in-house departments.
Conducting clinical screening process.
Authorizing initial set of sessions to provider.
Checking benefits for facility‑based treatment.
Developing and maintaining customer relations and coordinating with various functions to ensure prompt response to requests.
Executing multi‑tasking (calls, texts, facsimiles, electronic queues) while maintaining accuracy.
Maintaining focus during extended periods, handling multiple tasks in a fast‑paced high‑pressure environment.
Using strong verbal and written communication, empathy, persistence, and critical thinking skills.
Assuming a structured work schedule with occasional overtime and flexibility as needed.
Performing other duties as assigned.
Minimum Requirements
High School diploma or GED with at least 1 year of customer service or call‑center experience, or equivalent education/experience.
Preferred Skills, Capabilities and Experiences
Medical terminology training and experience in medical or insurance field.
Strong oral, written, interpersonal, problem‑solving, facilitation, and analytical skills.
Benefits
In addition to salary, benefits include a comprehensive package, incentive and recognition programs, equity stock purchase, 401(k) contribution, medical, dental, vision, disability, and other benefits subject to eligibility.
Seniority Level
Entry level
Employment Type
Full‑time
Job Function
Health Care Provider
Industries
Hospitals and Health Care
Equal Employment Opportunity
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.