Elevance Health
Utilization Management Representative I
Elevance Health, Columbus, Georgia, United States, 31900
Utilization Management Representative I
Elevance Health
Anticipated End Date: 2026-01-30
Job Description Assume the role of a full‑time, virtual associate, with occasional in‑person training sessions. This flexible arrangement promotes productivity, supports work‑life integration, and ensures essential onboarding and skill development. Candidates must be within a reasonable commuting distance unless an accommodation is granted under law.
The Utilization Management Representative I will coordinate cases for precertification and prior authorization review.
Responsibilities
Manage incoming calls or post services claims work.
Determine contract and benefit eligibility; authorize inpatient admission, outpatient precertification, prior authorization, and post‑service requests.
Refer cases requiring clinical review to a nurse reviewer.
Identify and 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 the clinical screening process.
Authorize the initial set of sessions to provider.
Check benefits for facility‑based treatment.
Develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
Minimum Requirements
High school diploma or GED.
Minimum of one year of customer service or call‑center experience; or an equivalent combination of education and experience.
Preferred Skills, Capabilities and Experiences
Medical terminology training and experience in a medical or insurance field preferred.
For URAC accredited areas, the following professional competencies apply: strong oral, written and interpersonal communication skills; problem‑solving skills; facilitation skills; and analytical skills.
Job Level: Non‑Management Non‑Exempt
Workshift: 3rd Shift (United States of America)
Job Family: CUS > Care Support
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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Anticipated End Date: 2026-01-30
Job Description Assume the role of a full‑time, virtual associate, with occasional in‑person training sessions. This flexible arrangement promotes productivity, supports work‑life integration, and ensures essential onboarding and skill development. Candidates must be within a reasonable commuting distance unless an accommodation is granted under law.
The Utilization Management Representative I will coordinate cases for precertification and prior authorization review.
Responsibilities
Manage incoming calls or post services claims work.
Determine contract and benefit eligibility; authorize inpatient admission, outpatient precertification, prior authorization, and post‑service requests.
Refer cases requiring clinical review to a nurse reviewer.
Identify and 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 the clinical screening process.
Authorize the initial set of sessions to provider.
Check benefits for facility‑based treatment.
Develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
Minimum Requirements
High school diploma or GED.
Minimum of one year of customer service or call‑center experience; or an equivalent combination of education and experience.
Preferred Skills, Capabilities and Experiences
Medical terminology training and experience in a medical or insurance field preferred.
For URAC accredited areas, the following professional competencies apply: strong oral, written and interpersonal communication skills; problem‑solving skills; facilitation skills; and analytical skills.
Job Level: Non‑Management Non‑Exempt
Workshift: 3rd Shift (United States of America)
Job Family: CUS > Care Support
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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