Utilization Management Representative Lead
Base pay range : $23.38/hr - $40.09/hr
Location : California, Nevada, Washington
Anticipated end date : 2025-11-08
Employment type : Full-time
Seniority level : Mid-Senior level
Job family : CUS > Care Support
This role enables associates to work virtually full‑time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy. The 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.
Hours
8:35 AM to 5:05 PM Pacific
How You Will Make an Impact
Motivates and encourages UM Reps while providing technical guidance.
Provides quality control services such as call monitoring and conducts UMR level I, II, and III audits for subsequent performance under NMIS and MTM standards.
Suggests methods to improve productivity.
Understands specific workflow, processes, departmental priorities and guidelines.
Monitors daily phone activities to exceed NMIS standards and improve customer service levels.
Assists in supervising the daily activities of a group of Behavioral Health Associates.
Provides direction and guidance to less experienced team members.
Assists manager with PTO scheduling and monitoring attendance.
Handles escalated and unresolved calls from less experienced team members.
Handles complex situations and ensures UM Reps are directed to the appropriate resources to resolve issues.
Keeps team members informed of any changes.
Assists management by identifying areas of improvement and recommends solutions.
Keeps manager informed of changes or problems.
Keeps departmental manuals up‑to‑date.
Researches resources for report generation for manager and ancillary departments.
Obtains, analyzes and presents statistical information as it relates to units of work, productivity, FTEs at work and time off.
May provide input into hiring decisions and performance appraisals.
Minimum Requirements
Requires HS diploma or equivalent and a minimum of 5 years related experience to include complex customer service or call center experience and medical terminology training; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities And Experiences
Knowledge of health plans, including familiarity with prior authorization and precertification process; knowledge of contracts and strong knowledge of managed benefit programs strongly preferred.
Reporting, presentation, training, and leadership experience strongly preferred.
Microsoft Excel experience strongly preferred.Certain contracts require a Master’s degree.
For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem‑solving skills, facilitation skills, and analytical skills.
Benefits
In addition to your salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution (all benefits are subject to eligibility requirements). The company is fully committed to ensuring 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, 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, and local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.