Elevance Health
Overview
Utilization Management Representative I (Florida) – Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing flexibility and autonomy. This approach promotes productivity, work-life integration, and essential face-to-face onboarding and skill development. The policy on hybrid/virtual work states that 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. The Utilization Management Representative I will be responsible for coordinating cases for precertification and prior authorization review. How you will make an impact
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. Minimum Requirements
HS diploma or GED 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. Customer Service and Prior Authorization experience preferred. Job Details
Job Level: Non-Management Employment type: Full-time Work shift: 1st Shift (United States of America) Job Family: Care Support Industry: Hospitals and Health Care 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, or 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.
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Utilization Management Representative I (Florida) – Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing flexibility and autonomy. This approach promotes productivity, work-life integration, and essential face-to-face onboarding and skill development. The policy on hybrid/virtual work states that 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. The Utilization Management Representative I will be responsible for coordinating cases for precertification and prior authorization review. How you will make an impact
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. Minimum Requirements
HS diploma or GED 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. Customer Service and Prior Authorization experience preferred. Job Details
Job Level: Non-Management Employment type: Full-time Work shift: 1st Shift (United States of America) Job Family: Care Support Industry: Hospitals and Health Care 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, or 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.
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