Utilization Management Representative I (Miami, FL) – CareBridge
Virtual: This role enables associates to work virtually full‑time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy.
Please note that candidates not within a reasonable commuting distance will not be considered, unless a law‑required accommodation is granted.
How you will make an impact
Managing incoming calls or post‑services claims work.
Determine contract and benefit eligibility; provide authorizations for inpatient admission, outpatient precertification, prior authorization, and post‑service requests.
Refer cases requiring clinical review to a Nurse reviewer.
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 processes.
Authorize initial set of sessions to provider.
Check benefits for facility‑based treatment.
Develop and maintain positive customer relations and coordinate with various functions to ensure timely handling of requests and questions.
Minimum Requirements
HS diploma or GED.
Minimum of 1 year of customer service or call‑center experience; or any combination of education and experience equivalent.
Preferred Skills, Capabilities and Experiences
Medical terminology training and experience in medical or insurance field.
Bilingual speaking preferred.
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.