Overview The Utilization Management Representative I coordinates cases for precertification and prior authorization review. This full-time, hybrid role may require in-person training and occasional office days. Hours are 8.5 hours per shift between 8 AM and 6 PM Eastern.
Base pay range $15.54/hr - $27.97/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. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
Responsibilities Managing incoming calls or incoming post services claims work.
Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
Refers cases requiring clinical review to a Nurse reviewer.
Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
Responds to telephone and written inquiries from clients, providers and in-house departments.
Conducts clinical screening process.
Authorizes initial set of sessions to provider.
Checks benefits for facility based treatment.
Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
Multi-tasks including handling calls, texts, facsimiles, and electronic queues, while taking notes and speaking to customers.
Maintains focus during extended periods of sitting and handling multiple tasks in a fast-paced environment; strong verbal and written communication skills; attention to detail; empathy and problem-solving to resolve caller issues; comfortable with digital tools to enhance productivity.
Structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.
Performs other duties as assigned.
Minimum Requirements Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities And Experiences Medical terminology training and experience in medical or insurance field preferred.
For URAC accredited areas, strong oral, written and interpersonal communication skills, problem-solving, facilitation, and analytical skills.
For candidates working in person or virtually in the below location(s), the salary range for this specific position is $15.54 to $27.97. Locations: Massachusetts, New York.
Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution. The salary offered is based on legitimate, non-discriminatory factors set by the Company. Elevance Health is committed to equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity employer. Qualified applicants will receive consideration for employment without regard to age, citizenship status, disability, race, color, creed, gender (including gender identity and gender expression), marital status, national origin, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable laws.