Elevance Health
Virtual: 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.
Utilization Management Representative I will coordinate cases for precertification and prior authorization review.
How You Will Make An Impact
Managing incoming calls or 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 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 process. Authorizing initial set of sessions to provider. Checking benefits for facility‑based treatment. Developing and maintaining positive customer relations and coordinating 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 that would provide an equivalent background. Preferred Skills, Capabilities And Experiences
Medical terminology training and experience in medical or insurance field preferred. Must be able to work weekends strongly preferred. Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry and leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at least once per week at an Elevance Health location, and potentially several times per week. Specific onsite requirements will be discussed as part of the hiring process. 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.
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Managing incoming calls or 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 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 process. Authorizing initial set of sessions to provider. Checking benefits for facility‑based treatment. Developing and maintaining positive customer relations and coordinating 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 that would provide an equivalent background. Preferred Skills, Capabilities And Experiences
Medical terminology training and experience in medical or insurance field preferred. Must be able to work weekends strongly preferred. Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry and leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at least once per week at an Elevance Health location, and potentially several times per week. Specific onsite requirements will be discussed as part of the hiring process. 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.
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