Join to apply for the Utilization Management Representative I role at Elevance Health
This range is provided by Elevance Health. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range
$16.31/hr - $26.81/hr
Location
This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered, unless an accommodation is granted as required by law. Shift hours are Monday through Friday from 7:00 AM to 5:00 PM Pacific.
Responsibilities
Manage incoming calls or 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 enter referral requests into the UM system in accordance with the plan certificate.
Respond to telephone and written inquiries from clients, providers, and in-house departments.
Conduct clinical screening process and authorize initial set of sessions to provider.
Check benefits for facility‑based treatment.
Develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
Multi‑task: handle calls, texts, facsimiles, and electronic queues while taking notes and speaking to customers.
Maintain focus during extended periods of sitting and handling multiple tasks in a fast‑paced, high‑pressure environment; demonstrate empathy and persistence to resolve caller issues completely.
Show proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.
Follow a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.
Perform other duties as assigned.
Minimum Requirements
HS diploma or GED and a minimum of 1 year of customer service or call‑center experience, or any combination of education and experience providing an equivalent background.
Preferred Skills, Capabilities and Experiences
Medical terminology training and experience in medical or insurance field preferred.
Strong oral, written, and interpersonal communication skills; problem‑solving, facilitation and analytical skills.
Equal Employment Opportunity Statement
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 (including gender identity and gender expression), 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.