Weekend shift hours may vary. How you will make an impact: * Managing incoming calls or incoming ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Weekend shift hours may vary. How you will make an impact: * Managing incoming calls or incoming ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Weekend shift hours may vary. How you will make an impact: * Managing incoming calls or incoming ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Weekend shift hours may vary. How you will make an impact: * Managing incoming calls or incoming ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
This position is fulltime remote. Selected candidate must reside in North Carolina. Some travel for ... Identify over/under utilization patterns and participate in analysis of practice patterns * Review ...
This position is fulltime remote. Selected candidate must reside in North Carolina. Some travel for ... Identify over/under utilization patterns and participate in analysis of practice patterns * Review ...
UM Clinical Specialist RN-Physical Health (Full-time Remote, NC Based)
Morrisville, NC · On-site +1
$68K - $86K/yr
This position is full-time remote. Selected candidate must reside in North Carolina and be willing ... Conduct utilization reviews to monitor adherence to clinical practice guidelines and best practice ...
UM Clinical Specialist RN-Physical Health (Full-time Remote, NC Based)
Morrisville, NC · On-site +1
$68K - $86K/yr
This position is full-time remote. Selected candidate must reside in North Carolina and be willing ... Conduct utilization reviews to monitor adherence to clinical practice guidelines and best practice ...
UM Clinical Specialist RN-Physical Health (Full-time Remote, NC Based)
Morrisville, NC · Remote
$68K - $86K/yr
This position is full-time remote. Selected candidate must reside in North Carolina and be willing ... Conduct utilization reviews to monitor adherence to clinical practice guidelines and best practice ...
UM Clinical Specialist RN-Physical Health (Full-time Remote, NC Based)
Morrisville, NC · Remote
$68K - $86K/yr
This position is full-time remote. Selected candidate must reside in North Carolina and be willing ... Conduct utilization reviews to monitor adherence to clinical practice guidelines and best practice ...
Dir-Utilization Management-Physical Health (Full-time Remote, Morrisville, NC Based)
Morrisville, NC · On-site +1
... appropriate utilization of both state and Medicaid funds. This position is full-time remote ... Oversee the UM Unit reviewing physical health services * Ensure consistent application of medical ...
Dir-Utilization Management-Physical Health (Full-time Remote, Morrisville, NC Based)
Morrisville, NC · On-site +1
... appropriate utilization of both state and Medicaid funds. This position is full-time remote ... Oversee the UM Unit reviewing physical health services * Ensure consistent application of medical ...
Dir-Utilization Management-Physical Health (Full-time Remote, Morrisville, NC Based)
Morrisville, NC · Remote
... appropriate utilization of both state and Medicaid funds. This position is full-time remote ... Oversee the UM Unit reviewing physical health services * Ensure consistent application of medical ...
Dir-Utilization Management-Physical Health (Full-time Remote, Morrisville, NC Based)
Morrisville, NC · Remote
... appropriate utilization of both state and Medicaid funds. This position is full-time remote ... Oversee the UM Unit reviewing physical health services * Ensure consistent application of medical ...
Physical Therapist
Durham, NC · On-site
$1.5K - $1.9K/wk
) Physical Therapist (PT) Full-Time | Part-Time | PRN Join Our Team & Earn a $10,000 Sign-On Bonus ... and utilization review meetings • Educate residents, families, and staff on therapy goals and ...
Physical Therapist
Durham, NC · On-site
$1.5K - $1.9K/wk
) Physical Therapist (PT) Full-Time | Part-Time | PRN Join Our Team & Earn a $10,000 Sign-On Bonus ... and utilization review meetings • Educate residents, families, and staff on therapy goals and ...
Work with Utilization Review staff relative to data tracking for performance review and outcomes of ... full time (40 hours per week) employment at the time of posting. The pay range may be higher or ...
Work with Utilization Review staff relative to data tracking for performance review and outcomes of ... full time (40 hours per week) employment at the time of posting. The pay range may be higher or ...
MDS Coordinator (RN)
$33.75 - $40.75/hr
MDS Coordinator (RN) Full-Time | Exempt | Day Shift We are seeking a clinically strong and highly ... Medicare, and utilization review meetings • Ensure timely completion, validation, and ...
Quick apply
MDS Coordinator (RN)
$33.75 - $40.75/hr
MDS Coordinator (RN) Full-Time | Exempt | Day Shift We are seeking a clinically strong and highly ... Medicare, and utilization review meetings • Ensure timely completion, validation, and ...
MDS Coordinator (RN)
Durham, NC · On-site
$33.75 - $40.75/hr
) MDS Coordinator (RN) Full-Time | Exempt | Day Shift We are seeking a clinically strong and highly ... Medicare, and utilization review meetings • Ensure timely completion, validation, and ...
MDS Coordinator (RN)
Durham, NC · On-site
$33.75 - $40.75/hr
) MDS Coordinator (RN) Full-Time | Exempt | Day Shift We are seeking a clinically strong and highly ... Medicare, and utilization review meetings • Ensure timely completion, validation, and ...
RN Care Manager - Rex Case Management Services
Raleigh, NC · On-site
$35.87 - $51.57/hr
... case management, utilization review and discharge planning. The Care Manager must be highly ... Rex Case Management Services Work Type: Full Time Standard Hours Per Week: 40.00 Salary Range: $35 ...
RN Care Manager - Rex Case Management Services
Raleigh, NC · On-site
$35.87 - $51.57/hr
... case management, utilization review and discharge planning. The Care Manager must be highly ... Rex Case Management Services Work Type: Full Time Standard Hours Per Week: 40.00 Salary Range: $35 ...
This role enables associates to work virtually full-time, except for required in-person training ... review. How you will make an impact: * Responsible for providing technical guidance to UM Reps who ...
This role enables associates to work virtually full-time, except for required in-person training ... review. How you will make an impact: * Responsible for providing technical guidance to UM Reps who ...
Utilization Management Representative I
Durham, NC · On-site
$36K - $41K/yr
This role enables associates to work virtually full-time, except for required in-person training ... Referring calls and cases requiring clinical review to a Nurse reviewer as needed through ...
Utilization Management Representative I
Durham, NC · On-site
$36K - $41K/yr
This role enables associates to work virtually full-time, except for required in-person training ... Referring calls and cases requiring clinical review to a Nurse reviewer as needed through ...
This role enables associates to work virtually full-time, with the exception of required in-person ... when conducting utilization review or an appeals consideration and cannot be located on a US ...
This role enables associates to work virtually full-time, with the exception of required in-person ... when conducting utilization review or an appeals consideration and cannot be located on a US ...
Appeals Medical Director - Oncology
Durham, NC · On-site
$247K - $446K/yr
This role enables associates to work virtually full-time, with the exception of required in-person ... when conducting utilization review or an appeals consideration and cannot be located on a US ...
Appeals Medical Director - Oncology
Durham, NC · On-site
$247K - $446K/yr
This role enables associates to work virtually full-time, with the exception of required in-person ... when conducting utilization review or an appeals consideration and cannot be located on a US ...
Appeals Medical Director- Dermatology
Durham, NC · On-site
$247K - $446K/yr
This role enables associates to work virtually full-time, with the exception of required in-person ... when conducting utilization review or an appeals consideration and cannot be located on a US ...
Appeals Medical Director- Dermatology
Durham, NC · On-site
$247K - $446K/yr
This role enables associates to work virtually full-time, with the exception of required in-person ... when conducting utilization review or an appeals consideration and cannot be located on a US ...
Appeals Medical Director - Urology
Durham, NC · On-site
$247K - $446K/yr
This role enables associates to work virtually full-time, with the exception of required in-person ... when conducting utilization review or an appeals consideration and cannot be located on a US ...
Appeals Medical Director - Urology
Durham, NC · On-site
$247K - $446K/yr
This role enables associates to work virtually full-time, with the exception of required in-person ... when conducting utilization review or an appeals consideration and cannot be located on a US ...
Service Manager Full Time Opportunity Summary Description Intakes customer vehicles, notes problems ... current resource utilization. * Review work-in-progress to ensure quality and timeliness.
Service Manager Full Time Opportunity Summary Description Intakes customer vehicles, notes problems ... current resource utilization. * Review work-in-progress to ensure quality and timeliness.
Medical Director
$248K - $298K/yr
Monday-Friday 8:00 AM-5:00 PM (Every Other Weekend) The Medical Director objective is to provide ... Participates in Utilization Review inclusive of but not limited to ED visits, hospitalizations, SNF ...
Medical Director
$248K - $298K/yr
Monday-Friday 8:00 AM-5:00 PM (Every Other Weekend) The Medical Director objective is to provide ... Participates in Utilization Review inclusive of but not limited to ED visits, hospitalizations, SNF ...
Full Time Weekend Utilization Review information
See Raleigh, NC salary details
$20.80 - $25
2% of jobs
$25 - $29.21
9% of jobs
$32.09 is the 25th percentile. Wages below this are outliers.
$29.21 - $33.42
21% of jobs
The median wage is $36.82 / hr.
$33.42 - $37.62
23% of jobs
$37.62 - $41.83
13% of jobs
$45.10 is the 75th percentile. Wages above this are outliers.
$41.83 - $46.03
10% of jobs
$46.03 - $50.24
8% of jobs
$50.24 - $54.45
5% of jobs
$54.45 - $58.65
5% of jobs
$58.65 - $62.86
2% of jobs
$62.86 - $67.06
2% of jobs
$20
$41
$67
How much do full time weekend utilization review jobs pay per hour?
What is the difference between Full Time Weekend Utilization Review vs Full Time Weekday Utilization Review?
| Aspect | Full Time Weekend Utilization Review | Full Time Weekday Utilization Review |
|---|---|---|
| Work Schedule | Primarily weekends and possibly some evenings | Primarily weekdays, Monday to Friday |
| Certifications | Typically requires medical or insurance-related certifications | Same certifications as weekend roles, often the same qualifications |
| Work Environment | Remote or office-based, with flexible hours on weekends | Standard office hours during weekdays |
| Employer & Industry | Healthcare insurance companies, utilization review organizations | Same industry, different scheduling focus |
Full Time Weekend Utilization Review roles focus on reviewing cases during weekends, offering flexibility for those who prefer weekend work. Full Time Weekday Utilization Review positions operate during standard business hours on weekdays. Both roles require similar certifications and work in the same industry, but differ mainly in scheduling and work hours.
- Remote Utilization Management
- Remote Prior Authorization Nurse
- Night Utilization Review Nurse
- Utilization Review Rn
- Utilization Management Nurse Consultant
- Evening Optum Health Utilization Review
- Overnight Utilization Review Nurse
- Utilization Review Physician
- Medical Review Nurse
- Full Time Appeals Nurse Remote
- Remote Utilization Review
- Utilization Review
- Remote Occupational Therapy Utilization Review
- Remote Aetna Utilization Review
- Remote Preservice Review Nurse
- Remote Aetna Utilization Review Nurse
- Utilization Review Salary
- Temporary Medical Utilization Review Physician
- Optum Utilization Review Nurse
- Full Time Navihealth Utilization Review
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 15 days ago
Elevance Health rating
7.7
Based on 345 frontline employees who took The Breakroom Quiz
175th of 263 rated insurance
Job description
Anticipated End Date:
2026-07-01Position Title:
Utilization Management Representative IJob Description:
Location: This role enables associates to work virtually full-time, except for 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. Alternate locations may be considered if candidates reside within a commuting distance from an office.
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.
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review.
Hours: Training is conducted from 7:00 AM to 3:30 PM Mountain Time, with standard shift hours from 8:30 AM to 5:30 PM Mountain Time. Please adjust for your time zone. Candidates will be required to work rotating weekends and select holidays, and must be flexible and available to work overtime. Weekend shift hours may vary.
How you will make an impact:
Managing incoming calls or incoming post services claims work.
Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.
Refers cases requiring clinical review to a Nurse reviewer.
Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
Responds to telephone and written inquiries from clients, providers and in-house departments.
Conducts clinical screening process.
Authorizes initial set of sessions to provider.
Checks benefits for facility based treatment.
Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
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.
Additional expectations to include but not limited to: 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.
Minimum Requirements:
Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
Inbound call center experience strongly preferred.
Medical terminology training and experience in medical or insurance field strongly preferred.
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.
Job Level:
Non-Management Non-ExemptWorkshift:
Job Family:
CUS > Care SupportPlease be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
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. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.
What Elevance Health employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Elevance Health
Sourced by ZipRecruiter
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Indianapolis, IN, US
Year founded
2004