Utilization Management Representative I Location: Virtual full‑time (hybrid required for onboarding and training). Candidates must be within a reasonable commuting distance if relocation is required per hybrid/virtual policy.
Hours: Monday–Friday, 7:00 AM–5:00 PM Pacific.
Job Description As a Behavioral Health Utilization Management Representative I, you will coordinate precertification and prior authorization reviews for both governmental and commercial business sectors.
How You Will Make an Impact Manage incoming calls and post service 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 plan certificates.
Respond to telephone and written inquiries from clients, providers, and internal departments.
Conduct clinical screening and authorizations for initial sessions.
Check benefits for facility‑based treatments.
Develop and maintain positive customer relations and coordinate with various functions to address inquiries timely.
Multi‑task across calls, texts, facsimiles, and electronic queues while maintaining detailed notes.
Maintain focus during extended periods of sitting and handle multiple tasks in a fast‑paced, high‑pressure environment.
Demonstrate strong verbal and written communication, problem‑solving, empirical thinking, empathy, and persistence in resolving caller issues.
Utilize digital tools and platforms to enhance productivity and minimize manual effort.
Work according to structured schedule; occasional overtime or flexibility based on business needs; ability to work from office as necessary.
Perform other duties as assigned.
Minimum Requirements High school diploma or GED and a minimum of 1 year of customer service or call‑center experience; or equivalent education‑experience combination.
Preferred Skills, Capabilities & Experience Medical terminology training and experience in a medical or insurance field.
Strong oral, written, interpersonal communication skills; problem‑solving, facilitation, and analytical skills.
Compensation Base pay range: $16.31 /hr – $26.81 /hr (geographically adjusted by location).
Benefits Elevance Health offers a comprehensive benefits package including medical, dental, vision, short‑ and long‑term disability, 401(k) with match, equity stock purchase, incentive and recognition programs, and more. Eligibility is subject to company requirements.
EEO Statement Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment with no regard to age, citizenship status, color, creed, disability, ethnicity, gender (including gender identity and expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other protected category. Applicants requiring accommodation may contact elevancehealthjobssupport@elevancehealth.com.