Utilization Management Representative II

Location 4751 Hamilton Wolf Rd, Ste 101, San Antonio, TX. The role requires full‑time, on‑site presence at this location. Candidates not within a reasonable commuting distance will not be considered unless an accommodation is granted as required by law. Schedule 8‑hour shift, Monday through Friday. Availability required from 8:00am to 6:00pm (CDT). Additional hours, including weekends or holidays, may be required based on operational needs. Job Overview The Utilization Management Representative II is responsible for managing incoming calls, including triage, opening of cases and authorizing sessions. Key Responsibilities Managing incoming calls or post‑services claim work. Determine contract and benefit eligibility and provide authorization for inpatient admission, outpatient precertification, prior authorization, and post‑service requests. Obtain intake (demographic) information from callers. Conduct a thorough radius search in Provider Finder and follow up with providers on referrals. Refer cases requiring clinical review to a nurse reviewer and handle referrals for specialty care. Process incoming requests and collect information needed for review from providers using scripts for pre‑certification and/or prior authorization. Verify benefits and/or eligibility information. Act as a liaison between Medical Management and internal departments. Respond to telephone and written inquiries from clients, providers, and in‑house departments. Conduct clinical screening processes. Minimum Requirements High school diploma or equivalent. Minimum 2 years of customer‑service experience in a healthcare‑related setting and medical terminology training, or an equivalent combination of education and experience. Preferred Skills and Experience Knowledge of health plans, including familiarity with prior authorization and precertification processes, and understanding of managed benefit programs. Previous experience managing prior authorization. Experience working in a high‑volume environment. Strong oral, written, interpersonal, problem‑solving, facilitation, and analytical skills. A Master’s degree may be required for certain contracts. Job Details Job Level: Non‑Management, Non‑Exempt. Workshift: 1st Shift (United States of America). Job Family: CUS > Care Support. Equal Employment Opportunity 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. #J-18808-Ljbffr