Utilization Management Representative II

Elevance Health

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

Posted 9/16/2026full-timeMason • Florida • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing authorization processes, including inpatient admissions and outpatient precertifications, while effectively communicating with clients and providers. Proficient in utilizing medical terminology and conducting thorough eligibility verifications.

Highest-signal resume keywords

Customer Service ExperienceMedical Terminology TrainingAuthorization ProcessesAnalytical SkillsInterpersonal Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Eligibility VerificationAuthorization for Inpatient AdmissionOutpatient PrecertificationCase ManagementData CollectionClinical Screening ProcessProvider Finder SearchesExcel Proficiency

Soft Skills

Problem-Solving SkillsFacilitation SkillsStrong Oral CommunicationWritten Communication Skills

Certifications & Qualifications

HS Diploma or EquivalentMaster's Degree (Preferred for Certain Contracts)

Industry Keywords

HealthcareClaims ManagementPatient AuthorizationReferral ManagementMedical Management

About the role

Key responsibilities & impact

Manage incoming calls, including triage, opening of cases and authorizing sessions
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
Obtain intake and demographic information from callers
Conduct thorough radius searches in Provider Finder and 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 review from providers
Utilize scripts to screen basic and complex requests for precertification and/or prior authorization
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

HS diploma or equivalent
Minimum of 2 years customer service experience in a healthcare related setting
Medical terminology training
Any combination of education and experience which would provide an equivalent background
Intermediate experience with excel is strongly preferred
Strong oral, written and interpersonal communication skills
Problem-solving skills
Facilitation skills
Analytical skills
Certain contracts require a Master's degree
Ability to work 8:00 am - 5:00 pm (EST) Monday to Friday
Candidates must reside 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 vaccination against COVID-19 and Influenza

Benefits

Comp & perks

merit increases
paid holidays
Paid Time Off
incentive bonus programs
medical benefits
dental benefits
vision benefits
short and 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
maximum flexibility and autonomy
personal and professional growth opportunities