Utilization Management Representative I

Elevance Health•Atlanta, GA

6d•Remote

About The Position

The Utilization Management Representative I is responsible for non-clinical tasks in a call center environment including performing outreach via outbound calls to members to connect them with a nurse for program enrollment and engagement, taking inbound available calls, working faxes, and calling facilities to request clinical. 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.

Requirements

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.

Nice To Haves

A strong ability to work independently as well as in small teams while contributing in a supportive way to the larger team strongly preferred.
Strong communication skills as well as an ability to pay close attention to detail, to multitask, and to prioritize work effectively strongly preferred.
Medical terminology training and experience in medical or insurance field preferred.
Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Responsibilities

Handling incoming calls accurately and in a positive way, routing them to the correct team as needed.
Determining contract and program eligibility as part of the outreach process.
Referring calls and cases requiring clinical review to a Nurse reviewer as needed through performing outreach, working faxes, callout for clinical and incoming calls.
Responsible for accurate and complete documentation of work in all appropriate systems.
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.
Responsible for tracking production and working reports, actively participating in the team plan daily.
Performs other duties as assigned.
Some examples of assorted projects include mentoring, creating job aids, and assorted administrative tasks.