Utilization Management Representative I

Elevance Health

. Coordinate cases for precertification and prior authorization review .

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

Core Competencies

Role fit

Core Competencies

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

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 utilizing digital tools to enhance productivity and maintain positive customer relations in a fast-paced environment.

Highest-signal resume keywords

Precertification CoordinationPrior Authorization ManagementCustomer Service ExperienceMedical Terminology KnowledgeStrong 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

PrecertificationPrior AuthorizationClinical ScreeningBenefit Eligibility DeterminationReferral Request Management

Soft Skills

Problem-SolvingEmpathyInterpersonal CommunicationAnalytical SkillsFacilitation

Tools & Technologies

UM SystemDigital ToolsElectronic Queues

Industry Keywords

Medical FieldInsurance FieldURAC AccreditationCustomer Relations

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 the initial set 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 promptly
Handle calls, texts, facsimiles and electronic queues while taking notes and speaking with customers
Demonstrate empathy and persistence to resolve caller issues completely
Use digital tools and platforms to improve productivity and reduce manual work
Perform other duties as assigned

Requirements

What you’ll need

High school diploma or GED and a minimum of 1 year of customer service or call-center experience; or 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, facilitation and 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
Ability to handle multiple tasks in a fast-paced, high-pressure environment
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
401(k) 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