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Utilization Management Representative I
Elevance Health. Coordinate cases for precertification and prior authorization review .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in precertification and prior authorization processes, with strong customer service skills and the ability to manage multiple tasks effectively. Proficient in medical terminology and experienced in Medicaid utilization management, ensuring accurate benefit eligibility and authorization.
Highest-signal resume keywords
Precertification CoordinationCustomer Service ExperienceMedical Terminology ProficiencyMedicaid Utilization ManagementStrong Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
PrecertificationPrior AuthorizationBenefit Eligibility DeterminationClaims ManagementReferral Request Entry
Soft Skills
Attention to DetailCritical ThinkingProblem-SolvingEmpathyPersistence
Tools & Technologies
UM SystemDigital ToolsElectronic Queues
Certifications & Qualifications
HS DiplomaGED
Industry Keywords
Medical FieldInsurance FieldMedicaid Waiver ProgramsCustomer Relations
About the role
Key responsibilities & impact- Coordinate cases for precertification and prior authorization review
- Manage incoming calls and post-service 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
- Authorize initial sessions to providers and 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
- Perform other duties as assigned
Requirements
What you’ll need- Must reside in Lake Mary, Tampa or Miami, Florida
- Must be available to work 4 days Monday–Friday from 8:30 am–5 pm EST plus one weekend day per week
- Requires 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 and experience in medical or insurance field preferred
- Experience with Medicaid waiver programs or other Medicaid utilization management experience preferred
- Ability to work from the office as necessary
- Ability to multitask while handling calls, texts, facsimiles, electronic queues, note-taking, and customer conversations
- Proficiency maintaining focus during extended periods of sitting
- Strong verbal and written communication skills
- Attention to detail, critical thinking, and problem-solving abilities
- Empathy and persistence in resolving caller issues
- Comfort and proficiency with digital tools and platforms
- Ability to work occasional overtime or adjust schedule based on business needs
Benefits
Comp & perks- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical benefits
- dental benefits
- vision benefits
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
- Virtual full-time work, except for required in-person training sessions