Utilization Management Representative I

Elevance Health

Utilization Management Representative coordinating precertification and prior authorization review in Tampa and Miami for Elevance Health. Managing calls, determining eligibility, and providing authorizations.

Posted 7/14/2026full-timeTampa • Florida • 🇺🇸 United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in precertification and prior authorization processes, with a strong focus on customer service and effective communication. Proficient in managing inquiries and coordinating clinical reviews while maintaining positive relationships with clients and providers.

Highest-signal resume keywords

Precertification CoordinationPrior Authorization ManagementCustomer Service ExperienceMedical Terminology KnowledgeMedicaid Utilization Management

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Contract Eligibility DeterminationClinical Screening ProcessAuthorization for Inpatient AdmissionAuthorization for Outpatient PrecertificationBenefit Verification

Soft Skills

Effective CommunicationCustomer Relations Management

Certifications & Qualifications

HS DiplomaGED

Industry Keywords

Medical FieldInsurance FieldMedicaid Waiver Programs

About the role

Key responsibilities & impact

Coordinating cases for precertification and prior authorization review
Managing incoming calls or incoming post services claims work
Determining contract and benefit eligibility
Providing authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
Referring cases requiring clinical review to a Nurse reviewer
Responding to telephone and written inquiries from clients, providers and in-house departments
Conducting clinical screening process
Authorizing initial set of sessions to provider
Checking benefits for facility based treatment
Developing and maintaining positive customer relations

Requirements

What you’ll need

Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience
Medical terminology training and experience in medical or insurance field preferred
Experience with Medicaid waiver programs or other Medicaid utilization management experience preferred

Benefits

Comp & perks

Affordable Health Insurance
Dental
Vision
Basic Life
401K match
Paid Time Off
Holiday Pay
Annual incentive bonus and annual increases plan based on performance
Opportunity for growth with further education reimbursement