Utilization Management Representative I

Elevance Health

. Coordinate cases for precertification and prior authorization review .

Posted 10/26/2026full-timeUnited StatesJunior💰 $17 - $28 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in precertification and prior authorization processes, with strong communication and problem-solving skills to effectively manage customer inquiries and coordinate with healthcare providers. Proficient in using digital tools to enhance productivity and maintain customer relations in a fast-paced environment.

Highest-signal resume keywords

Precertification CoordinationCustomer Service ExperienceMedical Terminology KnowledgeStrong Communication SkillsProblem-Solving Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

PrecertificationPrior AuthorizationClinical ScreeningBenefit Eligibility DeterminationReferral ManagementAttention to DetailAnalytical SkillsMultitaskingDigital Tools ProficiencyMedical Insurance Knowledge

Soft Skills

Interpersonal SkillsEmpathyPersistenceCritical ThinkingFacilitation Skills

Tools & Technologies

UM SystemDigital PlatformsElectronic Queues

Certifications & Qualifications

HS DiplomaGED

Industry Keywords

HealthcareInsuranceURAC AccreditationCustomer RelationsPatient Care

About the role

Key responsibilities & impact

Coordinate cases for precertification and prior authorization review
Manage incoming calls or incoming post-services claims work
Determine contract and benefit eligibility
Provide authorization for 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 according to the plan certificate
Respond to telephone and written inquiries from clients, providers, and in-house departments
Conduct clinical screening processes
Authorize initial sets of sessions to providers
Check benefits for facility-based treatment
Develop and maintain positive customer relations
Coordinate with company functions to handle customer requests and questions appropriately and promptly
Handle calls, texts, facsimiles, and electronic queues while taking notes and speaking with customers
Use digital tools and platforms to enhance productivity and minimize manual efforts
Work a structured schedule with occasional overtime or flexibility based on business needs
Perform other duties as assigned

Requirements

What you’ll need

HS diploma or GED
Minimum of 1 year of customer service or call-center experience
Any combination of education and experience providing an equivalent background
Medical terminology training preferred
Experience in a medical or insurance field preferred
Strong oral, written, and interpersonal communication skills for URAC-accredited areas
Problem-solving, facilitation, and analytical skills for URAC-accredited areas
Ability to work within a commuting distance from a posting location unless accommodation is granted
Ability to work from the office as necessary
Ability to maintain focus during extended periods of sitting
Ability to multitask in a fast-paced, high-pressure environment
Strong verbal and written communication skills
Attention to detail, critical thinking, and problem-solving skills
Empathy and persistence in resolving caller issues
Ability to use digital tools and platforms
Ability to work a structured schedule with occasional overtime or flexibility
For certain patient/member-facing roles, vaccination against COVID-19 and Influenza is required unless an acceptable explanation is provided

Benefits

Comp & perks

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short-term disability benefits
Long-term disability benefits
401(k) with match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Virtual full-time work, except for required in-person training sessions
Flexible work-life integration
Occasional overtime or schedule flexibility based on business needs