Utilization Management Specialist II

Utilization Management Specialist II This position allows team members to work virtually full-time, with the exception of necessary in-person training sessions, offering flexibility and autonomy. This setup enhances productivity, promotes work-life balance, and ensures effective onboarding and skill development. Please note that candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless legally required accommodations are provided. Hours: Monday through Friday 9:30 AM to 6:00 PM Pacific time. Please adjust for your time zone. The Utilization Management Specialist II plays a key role in managing incoming calls, triaging requests, opening cases, and authorizing sessions. Key Responsibilities: Handle incoming calls and post-service claims work efficiently. Determine contract and benefit eligibility; authorize inpatient admissions, outpatient precertifications, prior authorizations, and post-service requests. Collect demographic information from callers during the intake process. Conduct thorough searches in Provider Finder and follow up with providers on referrals. Refer cases needing clinical review to nurse reviewers; manage referrals for specialty care. Process incoming requests and gather required information from providers, using prepared scripts for screening precertification and prior authorization requests. Verify benefits and eligibility information accurately. Act as a liaison between Medical Management and internal departments. Respond to inquiries from clients, providers, and internal departments via phone and written communication. Conduct clinical screening processes as needed. Minimum Qualifications: High School Diploma or equivalent and at least 2 years of customer service experience in a healthcare environment, along with medical terminology training; or an equivalent combination of education and experience. Preferred Qualifications: Bilingual in Spanish is preferred. Excellent oral, written, and interpersonal communication skills, alongside strong problem-solving, facilitation, and analytical capabilities. A Master's degree may be required for certain contracts. This position offers a salary range of $18.13 to $31.09. The selected candidates will receive a comprehensive benefits package, including incentive programs, stock purchase options, and 401k contributions (subject to eligibility requirements). Salary is based on legitimate, non-discriminatory factors set by the company. Elevance Health is committed to equal pay opportunities for equal work, regardless of gender, race, or other legally protected categories. The range presented reflects the company's good faith estimate for this role at the time of posting and may be adjusted in the future. Actual compensation may vary based on geographic location, work experience, education, and skill level. Please be aware that Elevance Health only accepts resumes from agencies with a signed agreement. Any unsolicited resumes, including those submitted directly to hiring managers, become the property of Elevance Health. About Us Elevance Health is dedicated to improving lives and communities by making healthcare more straightforward. As a Fortune 25 company with a longstanding history in the healthcare sector, we seek passionate leaders at all levels to make an impact on our members and communities. Work Culture At Elevance Health, we are committed to a culture designed to promote our strategy and facilitate personal and professional growth for our associates. Our core values and behaviors drive our success and benefit our consumers, associates, communities, and business. We offer competitive total rewards, including merit increases, paid holidays, Paid Time Off, incentive programs, comprehensive benefits, and financial education resources. The health of our associates and communities is paramount. We require that new candidates for specific roles obtain vaccinations against COVID-19 and Influenza. If not vaccinated, an acceptable explanation is necessary to continue with the offer process. We adhere to all applicable federal, state, and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will be considered without regard to any protected category. Applicants needing accommodation during the application process may reach out for assistance. Qualified applicants with arrests or conviction records will be evaluated according to all relevant laws, including the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Created: 2026-03-11