Overview Position Title: Utilization Management Representative I
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions. Hours: 8.5 hour shift between 8 AM and 6 PM Eastern. This role supports work-life integration and on-site onboarding as needed.
Anticipated End Date: 2025-11-06
Base pay range $15.54/hr - $27.97/hr
Summary The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization reviews and for providing high-quality service to members and providers.
Responsiblities Managing incoming calls and related post-service claims work.
Determining contract and benefit eligibility; providing authorization for inpatient admission, outpatient precertification, prior authorization, and post-service requests.
Referring cases requiring clinical review to a Nurse reviewer.
Identifying and data entering referral requests into the UM system in accordance with the plan certificate.
Responding to telephone and written inquiries from clients, providers and in-house departments.
Conducting clinical screening processes.
Authorizing initial set of sessions to providers.
Checking benefits for facility-based treatment.
Developing and maintaining positive customer relations and coordinating with various functions to ensure requests and questions are handled promptly.
Multi-tasking across calls, texts, facsimiles, and electronic queues while taking notes and speaking to customers.
Demonstrating focus, strong verbal and written communication skills, attention to detail, critical thinking, and problem-solving; maintaining empathy and persistence to resolve issues completely.
Working a structured schedule with occasional overtime or flexibility based on business needs; may require in-office work.
Performing other duties as assigned.
Minimum Requirements HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or equivalent background.
Preferred Skills, Capabilities And Experiences Medical terminology training and experience in medical or insurance fields preferred.
URAC-accredited areas require strong oral, written, and interpersonal communication, problem-solving, facilitation, and analytical skills.
Salary and location specifics For candidates working in person or virtually in the locations below, the salary range for this position is $15.54 to $27.97. Locations: Massachusetts, New York.
Benefits and equal opportunity In addition to salary, Elevance Health offers a comprehensive benefits package including incentive programs, stock purchase plans, 401(k) contribution, health benefits, wellness programs, and more. The company is committed to equal pay opportunities and equal employment regardless of protected characteristics. Reasonable accommodations during the application process are available.
Elevance Health operates in a Hybrid Workforce Strategy. Time onsite expectations will be discussed during the hiring process. Vaccination requirements may apply for certain patient/member-facing roles in line with applicable laws.
Legal notices Elevance Health is an Equal Employment Opportunity employer. Resumes from agencies must be submitted under a signed agreement. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.
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