Utilization Management Representative

After hours Utilization Management Representative I

Location
:
This role enables associates to work virtually full-time, except for required in‑person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work‑life integration, and ensures essential face‑to‑face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment unless accommodation is granted as required by law.

Hours
:
Fri/Sat/Sun/Mon, 1 AM - 11:30 AM EST

The After hours Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review.

• Managing incoming calls or incoming post services claims work.
• Determining contract and benefit eligibility; providing authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
• Referring cases requiring clinical review to a Nurse reviewer.
• Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
• Responding to telephone and written inquiries from clients, providers and in‑house departments.
• Conducting clinical screening process.
• Authorizing initial set of sessions to provider.
• Checking benefits for facility‑based treatment.
• Developing and maintaining positive customer relations and coordinating with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
• Associates in this role are expected to have the ability to multi‑task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.
• Additional expectations include proficiency in maintaining focus during extended periods of sitting and handling multiple tasks in a fast‑paced, high‑pressure environment; strong verbal and written communication skills, both with virtual and in‑person interactions; attention to detail, critical thinking, and problem solving; demonstrating empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.
• Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.
• Performing other duties as assigned.

Requires HS 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.

• Experience in a call center / call queue environment strongly preferred.
• Medical terminology training and experience in medical or insurance field preferred.

For URAC accredited areas, the following professional competencies apply:
Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem‑solving skills, facilitation skills, and analytical skills.

We offer a range of market‑competitive total rewards that include merit increases, paid holidays, paid time off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long‑term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

We require all new candidates in certain patient/member‑facing roles to become…