Utilization Management Representative I
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Posted: 10/20/2026Utilization Management Representative I
Elevance HealthCore 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 inquiries effectively. Proficient in medical terminology and capable of conducting clinical screenings while maintaining attention to detail in a fast-paced environment.
Highest-signal resume keywords
Customer Service ExperienceMedical Terminology ProficiencyCall Center ExperienceAnalytical SkillsProblem-Solving Skills
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 in accordance with 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 various company functions to handle customer requests and questions appropriately and promptly
- Handle calls, texts, facsimiles, and electronic queues while taking notes and speaking to customers
- Work occasional overtime or schedule 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 which would provide an equivalent background
- Inbound call center experience strongly preferred
- Medical terminology training and experience in medical or insurance field strongly preferred
- Strong oral, written and interpersonal communication skills
- Problem-solving skills
- Facilitation skills
- Analytical skills
- Ability to work rotating weekends and select holidays
- Flexibility and availability to work overtime
- Ability to multitask in a fast-paced, high-pressure environment
- Ability to maintain focus during extended periods of sitting
- Attention to detail, critical thinking, and problem-solving ability
- Comfort and proficiency with digital tools and platforms
- Ability to work from the office as necessary
- For certain patient/member-facing roles, vaccination against COVID-19 and Influenza is required unless an acceptable explanation is provided
Benefits
Comp & perks- 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) + match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Virtual full-time work, except for required in-person training sessions
- Professional growth opportunities
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Soft Skills
Strong Oral CommunicationWritten CommunicationInterpersonal CommunicationAttention to DetailCritical Thinking
Tools & Technologies
UM SystemDigital ToolsElectronic Queues
Certifications & Qualifications
HS DiplomaGED
Industry Keywords
PrecertificationPrior AuthorizationClinical ReviewBenefit EligibilityCustomer Relations