Utilization Management Representative I

Elevance Health

. Coordinate cases for precertification and prior authorization review .

Posted 10/26/2026full-timeUnited StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates strong customer service skills, effective communication, and problem-solving abilities while coordinating precertification and prior authorization processes in a medical or insurance environment.

Highest-signal resume keywords

Customer Service ExperienceMedical Terminology TrainingProblem-Solving SkillsAnalytical SkillsInterpersonal Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Precertification CoordinationPrior Authorization ReviewClinical Screening ProcessBenefit Eligibility DeterminationReferral Request Management

Soft Skills

Attention to DetailCritical ThinkingEmpathyPersistenceFacilitation Skills

Tools & Technologies

UM SystemDigital ToolsElectronic Queues

Certifications & Qualifications

HS DiplomaGED

Industry Keywords

Medical FieldInsurance FieldURAC Accreditation

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 process
Authorize initial set of sessions to provider
Check benefits for facility based treatment
Develop and maintain positive customer relations
Coordinate with various functions within the company to handle customer requests and questions appropriately and timely
Handle calls, texts, facsimiles, and electronic queues while taking notes and speaking to customers
Apply attention to detail, critical thinking, and problem-solving skills 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 which would provide 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 skills for URAC accredited areas
Facilitation skills for URAC accredited areas
Analytical skills for URAC accredited areas
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
COVID-19 and Influenza vaccination may be required for certain patient/member-facing roles

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) 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
Professional and personal growth opportunities