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 strong customer service skills with the ability to manage precertification and prior authorization processes effectively. Proficient in problem-solving, critical thinking, and utilizing digital tools to enhance productivity in a fast-paced environment.

Highest-signal resume keywords

Customer Service ExperienceMedical Terminology KnowledgeProblem-Solving SkillsStrong Communication SkillsAttention To Detail

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Precertification CoordinationPrior Authorization ReviewClinical Screening ProcessBenefit Eligibility DeterminationReferral Request Management

Soft Skills

EmpathyCritical ThinkingMultitaskingPersistenceInterpersonal Communication

Tools & Technologies

UM SystemDigital ToolsElectronic Queues

Industry Keywords

Medical Field ExperienceInsurance Field ExperienceURAC AccreditationCOVID-19 Vaccination RequirementHigh-Pressure Environment

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 the clinical screening process
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
Multitask across calls, texts, facsimiles and electronic queues while taking notes and speaking with customers
Apply attention to detail, critical thinking and problem-solving to resolve issues
Demonstrate empathy and persistence to resolve caller issues completely
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
For URAC accredited areas: strong oral, written and interpersonal communication skills
Problem-solving, facilitation and analytical skills
Ability to work a structured schedule with occasional overtime or flexibility based on business needs
Ability to work from the office as necessary
Ability to maintain focus during extended periods of sitting
Ability to handle multiple tasks in a fast-paced, high-pressure environment
Strong verbal and written communication skills for virtual and in-person interactions
Attention to detail, critical thinking and problem-solving skills
Ability to use digital tools and platforms
Ability to work within commuting distance of a posting location unless accommodation is granted
New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, 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 required in-person training sessions
Flexible work-life integration and autonomy