Utilization Management Representative II

Elevance Health

. Manage incoming calls, including triage, opening cases, and authorizing sessions .

Posted 10/9/2026full-timeLake Mary • Florida • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in managing authorization processes, including inpatient admissions and outpatient precertification, while effectively communicating with clients and providers. Proficient in medical terminology and capable of handling multiple responsibilities in a fast-paced healthcare environment.

Highest-signal resume keywords

Medical Terminology TrainingCustomer Service ExperienceAuthorization ManagementAnalytical SkillsInterpersonal Communication Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

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

Hard Skills

Authorization For Inpatient AdmissionsOutpatient PrecertificationPrior AuthorizationBenefit VerificationClaims ProcessingClinical Screening ProcessProvider ReviewsDemographic Intake InformationTriage ManagementRadius Searches

Soft Skills

Problem-Solving SkillsFacilitation SkillsStrong Oral CommunicationWritten Communication SkillsInterpersonal Communication Skills

Certifications & Qualifications

High School DiplomaMaster's Degree (Preferred)

Industry Keywords

HealthcareMedical ManagementInsurance Field ExperienceCOVID-19 Vaccination RequirementInfluenza Vaccination Requirement

About the role

Key responsibilities & impact

Manage incoming calls, including triage, opening cases, and authorizing sessions
Manage incoming post-service claims work
Determine contract and benefit eligibility
Provide authorization for inpatient admissions, outpatient precertification, prior authorization, and post-service requests
Obtain demographic intake information from callers
Conduct radius searches in Provider Finder
Follow up with providers on referrals
Refer cases requiring clinical review to nurse reviewers
Handle referrals for specialty care
Process incoming requests and collect information needed for provider reviews
Use scripts to screen basic and complex precertification and prior authorization requests
Verify benefits and eligibility information
Act as liaison between Medical Management and internal departments
Respond to telephone and written inquiries from clients, providers, and in-house departments
Conduct the clinical screening process

Requirements

What you’ll need

High school diploma or equivalent
Minimum of 2 years customer service experience in a healthcare-related setting
Medical terminology training
Strong oral, written, and interpersonal communication skills
Problem-solving skills
Facilitation skills
Analytical skills
Medical or insurance field experience preferred
Ability to adapt to evolving technologies
Ability to manage multiple responsibilities
Certain contracts require a Master's degree
Must reside in Lake Mary, Tampa, or Miami, Florida
Must be available to work 4 days Monday–Friday from 12 p.m.–9 p.m. EST plus one weekend day per week
Candidates must be within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
Certain patient/member-facing roles require COVID-19 and Influenza vaccination unless an acceptable explanation is provided

Benefits

Comp & perks

10% shift differential for the required weekend day
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