Utilization Management Representative III

Anticipated End Date

Utilization Management Representative III

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

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.

• Responsible for providing technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services outside of initial authorized set.

• Assisting management by identifying areas of improvement and expressing a willingness to take on new projects as assigned.

• Handling escalated and unresolved calls from less experienced team members.

• Ensuring UM Reps are directed to the appropriate resources to resolve issues.

• Ability to understand and explain specific workflow, processes, departmental priorities and guidelines.

• May assist in new hire training to act as eventual proxy for Ops Expert.

• Exemplifies behaviors embodied in the 5 Core Values.

• 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.

• 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.

• HS diploma or GED
• Minimum of 3 years of experience in customer service experience in a healthcare related setting; or any combination of education and experience which would provide an equivalent background.

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.

For candidates working in person or virtually in the below location(s), the salary
* range for this specific position is $21.73/hr to $32.59/hr.

Locations:
New York

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non‑discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations.

No amount is considered to be wages or compensation…