Utilization Management Representative I

Position Overview 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. Alternate locations may be considered if candidates reside within a commuting distance from an office. 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: Standard shift hours Monday through Friday, 8:30 AM to 5 PM Eastern. Evening shifts will be required on a rotating basis: 11:30 AM to 8 PM Eastern and/or 12:30 PM to 9 PM Eastern. Responsibilities Perform outreach via outbound calls to members to connect them with a nurse for program enrollment and engagement. Take inbound available calls. Work faxes and call facilities to request clinical. Handle incoming calls accurately and positively, routing them to the correct team as needed. Determine contract and program eligibility as part of the outreach process. Refer calls and cases requiring clinical review to a Nurse reviewer as needed through performing outreach, working faxes, callout for clinical and incoming calls. Document work accurately and completely in all appropriate systems. Develop and maintain positive customer relations and coordinate with various functions to ensure requests and questions are handled appropriately and timely. Track production and working reports, actively participate in the team plan daily. Perform other duties as assigned; e.g., mentoring, creating job aids, assorted administrative tasks. Minimum Qualifications High school diploma or GED and a minimum of 1 year of customer service or call‑center experience; or any combination of education and experience equivalent to this background. Preferred Skills, Capabilities and Experiences Strong ability to work independently and in small teams, contributing to the larger team. Strong communication skills; ability to pay close attention to detail, multitask, and prioritize work effectively. Medical terminology training and experience in the medical or insurance field. For URAC accredited areas: strong oral, written, interpersonal communication; problem‑solving, facilitation and analytical skills. Job Details Job Level: Non‑Management Workshift: Non‑Exempt Job Family: CUS > Care Support Benefits Market‑competitive total rewards including merit increases, paid holidays, paid time off, incentive bonus programs, medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources. Equal Employment Opportunity Statement 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 and local laws. #J-18808-Ljbffr