E
Utilization Management Representative I
Elevance Health
10 hours ago
Contract
On-site
Lake Mary, Florida, United States
Registered Nurse
Anticipated End Date:
2026-09-15
Position Title:
Utilization Management Representative I
Job Description:
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 an accommodation is granted as required by
law.
The Utilization Management Representative I is responsible for coordinating
cases for precertification and prior authorization review.
Hours: Training is conducted from 7:00 AM to 3:30 PM Mountain Time, with
standard shift hours from 8:30 AM to 5:30 PM Mountain Time. Please adjust for
your time zone. Candidates will be required to work rotating weekends and select
holidays, and must be flexible and available to work overtime. Weekend shift
hours may vary.
How you will make an impact:
* 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.
* 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 to include but not limited to: Proficient 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; attentive
to details, critical thinker, and a problem-solver; demonstrates 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.
* Performs other duties as assigned.
Minimum 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.
Preferred Skills, Capabilities and Experiences:
* Inbound call center experience strongly preferred.
* Medical terminology training and experience in medical or insurance field
strongly 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.
Job Level:
Non-Management Non-Exempt
Workshift:
Job Family:
CUS > Care Support
Please be advised that Elevance Health only accepts resumes for compensation
from agencies that have a signed agreement with Elevance Health. Any unsolicited
resumes, including those submitted to hiring managers, are deemed to be the
property of Elevance Health.
Who We Are
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.
How We Work
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 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.
The health of our associates and communities is a top priority for Elevance
Health. We require all new candidates in certain patient/member-facing roles to
become vaccinated against COVID-19 and Influenza. If you are not vaccinated,
your offer will be rescinded unless you provide an acceptable explanation.
Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified
applicants will receive consideration for employment without regard to age,
citizenship status, color, creed, disability, ethnicity, genetic information,
gender (including gender identity and gender expression), marital status,
national origin, race, religion, sex, sexual orientation, veteran status or any
other status or condition protected by applicable federal, state, or local laws.
Applicants who require accommodation to participate in the job application
process should submit the following form: Accessibility Accommodation Request
Form
[https://forms.cloud.microsoft/pages/responsepage.aspx?id=8giMvgesLESaRuvu61vU17EJaA0EP3FIissI8zmZ_NpUNUgyTFRUMkY5NE5JNDFWMkhaUzQxMkJLWS4u&route=shorturl]
and a member of the team will be in contact. Qualified applicants with arrest or
conviction records will be considered for employment in accordance with all
federal, state, and local laws, including, but not limited to, the Los Angeles
County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review
the education and awareness resources at HB531 | Florida Agency for Health Care
Administration [https://info.flclearinghouse.com/].
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before
the listed end date. Example: If the end date is 3/13, the posting will
automatically come down on 3/12 at 11:59:59 PM. In other words — the job is
posted until 3/13, not through 3/13.
2026-09-15
Position Title:
Utilization Management Representative I
Job Description:
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 an accommodation is granted as required by
law.
The Utilization Management Representative I is responsible for coordinating
cases for precertification and prior authorization review.
Hours: Training is conducted from 7:00 AM to 3:30 PM Mountain Time, with
standard shift hours from 8:30 AM to 5:30 PM Mountain Time. Please adjust for
your time zone. Candidates will be required to work rotating weekends and select
holidays, and must be flexible and available to work overtime. Weekend shift
hours may vary.
How you will make an impact:
* 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.
* 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 to include but not limited to: Proficient 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; attentive
to details, critical thinker, and a problem-solver; demonstrates 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.
* Performs other duties as assigned.
Minimum 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.
Preferred Skills, Capabilities and Experiences:
* Inbound call center experience strongly preferred.
* Medical terminology training and experience in medical or insurance field
strongly 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.
Job Level:
Non-Management Non-Exempt
Workshift:
Job Family:
CUS > Care Support
Please be advised that Elevance Health only accepts resumes for compensation
from agencies that have a signed agreement with Elevance Health. Any unsolicited
resumes, including those submitted to hiring managers, are deemed to be the
property of Elevance Health.
Who We Are
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.
How We Work
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 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.
The health of our associates and communities is a top priority for Elevance
Health. We require all new candidates in certain patient/member-facing roles to
become vaccinated against COVID-19 and Influenza. If you are not vaccinated,
your offer will be rescinded unless you provide an acceptable explanation.
Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified
applicants will receive consideration for employment without regard to age,
citizenship status, color, creed, disability, ethnicity, genetic information,
gender (including gender identity and gender expression), marital status,
national origin, race, religion, sex, sexual orientation, veteran status or any
other status or condition protected by applicable federal, state, or local laws.
Applicants who require accommodation to participate in the job application
process should submit the following form: Accessibility Accommodation Request
Form
[https://forms.cloud.microsoft/pages/responsepage.aspx?id=8giMvgesLESaRuvu61vU17EJaA0EP3FIissI8zmZ_NpUNUgyTFRUMkY5NE5JNDFWMkhaUzQxMkJLWS4u&route=shorturl]
and a member of the team will be in contact. Qualified applicants with arrest or
conviction records will be considered for employment in accordance with all
federal, state, and local laws, including, but not limited to, the Los Angeles
County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review
the education and awareness resources at HB531 | Florida Agency for Health Care
Administration [https://info.flclearinghouse.com/].
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before
the listed end date. Example: If the end date is 3/13, the posting will
automatically come down on 3/12 at 11:59:59 PM. In other words — the job is
posted until 3/13, not through 3/13.