Utilization Management Representative I​/II

Anticipated End Date:

Position Title: Utilization Management Representative I/II

Virtual:
This role enables associates to work virtually full-time, with the exception of 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.

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 an accommodation is granted as required by law.

The Utilization Management Representative I/II will be responsible for coordinating cases for precertification and prior authorization review.

• Managing incoming calls or incoming post services claims work.
• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
• Refers 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.
• Responds to telephone and written inquiries from clients, providers and in‑house departments.
• Conducts clinical screening process.
• Authorizes initial set of sessions to provider.
• Checks benefits for facility based treatment.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

• A career path with opportunity for growth
• Ability to obtain your Associate’s or Bachelor’s degree or further your education with tuition reimbursement.
• Affordable Health Insurance, Dental, Vision and Basic Life
• 401K match, Paid Time Off, Holiday Pay
• Annual incentive bonus and annual increases plan based on performance.

At Elevance Health, the team is comprised of the best and the brightest from diverse experiences, cultures, and backgrounds. The differences we each bring to the table are a part of what makes our company so successful.

Utilization Management Representative I

• HS diploma or GED
• Minimum of 1 year of customer service or call‑center experience; or any combination of education and experience which would provide an equivalent background.

Utilization Management Representative II

• HS diploma or equivalent.
• Minimum of 2 years customer service experience in healthcare related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background.

Utilization Management Representative I/II

• Medical terminology training and experience in medical or insurance field preferred.

For candidates working in person or virtually in the below location(s), the salary
* range for this specific position is $16.32/hr to $27.21/hr.

Locations:
New York

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations.

No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form…