Utilization Management Representative

Anticipated End Date:

Position Title: Utilization Management Representative I

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.

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

• Managing incoming calls or 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.
• Identifying and data‑entering 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.
• Handling calls, texts, facsimiles and electronic queues while simultaneously taking notes and speaking to customers.
• Demonstrating 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, empathy, persistence and problem‑solving ability; and comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual effort.
• Having 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.

• 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.

• Medical terminology training and experience in medical or insurance field preferred.
• Behavioral health medical terminology strongly preferred.
• For URAC accredited areas, strong oral, written and interpersonal communication skills, problem‑solving skills, facilitation skills, and analytical skills.

Non‑Management Non‑Exempt

Job Family: CUS >
Care Support

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success – for our consumers, our associates, our communities and our business.

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…