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Utilization Management Representative Ii information

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$24.5K

$44.2K

$77K

How much do utilization management representative ii jobs pay per year?

As of Jun 9, 2026, the average yearly pay for utilization management representative ii in the United States is $44,219.00, according to ZipRecruiter salary data. Most workers in this role earn between $37,500.00 and $43,000.00 per year, depending on experience, location, and employer.

How does a Utilization Management Representative II collaborate with healthcare providers and insurance teams to ensure timely authorizations?

As a Utilization Management Representative II, you will regularly communicate with healthcare providers to gather necessary clinical information and clarify treatment plans. You'll also coordinate closely with insurance teams to review coverage policies and ensure that authorization requests are processed efficiently. This role requires balancing the needs of patients, providers, and payers, often managing multiple cases simultaneously. Strong organizational skills and clear communication are essential to keep workflows smooth and timely, especially when dealing with urgent or complex cases.

What are the key skills and qualifications needed to thrive as a Utilization Management Representative II, and why are they important?

To thrive as a Utilization Management Representative II, you need strong knowledge of healthcare regulations, medical terminology, and insurance processes, usually supported by a healthcare-related degree or relevant experience. Familiarity with utilization management software, claims processing systems, and electronic medical records is typically required. Excellent communication, attention to detail, and problem-solving skills help you effectively coordinate care and interact with providers and members. These abilities ensure accurate benefit determinations, regulatory compliance, and efficient patient care management.

What is the difference between Utilization Management Representative Ii vs Utilization Management Representative I?

AspectUtilization Management Representative IiUtilization Management Representative I
CredentialsHigh school diploma or equivalent; certification preferredHigh school diploma or equivalent; certification optional
Work EnvironmentHealthcare insurance companies, hospitals, or clinicsHealthcare insurance companies, hospitals, or clinics
ResponsibilitiesReviewing medical necessity, supporting case evaluations, handling complex casesAssisting with case reviews, data entry, basic case assessments

The main difference between Utilization Management Representative Ii and I lies in experience and complexity of tasks. The Ii role typically involves more complex case reviews and may require additional certifications, whereas the I role focuses on foundational tasks and data entry. Both positions are common in healthcare insurance settings and share similar work environments.

What does a Utilization Management Representative II do?

A Utilization Management Representative II is responsible for reviewing medical service requests and determining if they meet established criteria for coverage under a health insurance plan. They collaborate with healthcare providers, patients, and insurance companies to ensure services are medically necessary and efficiently managed. This role typically involves processing prior authorizations, verifying benefits, and communicating decisions regarding coverage. Utilization Management Representatives help ensure patients receive appropriate care while controlling costs for both the insurer and the patient.
More about Utilization Management Representative Ii jobs
What job categories do people searching Utilization Management Representative Ii jobs look for? The top searched job categories for Utilization Management Representative Ii jobs are:
Utilization Management Representative Ii jobs near you
Infographic showing various Utilization Management Representative Ii job openings in the United States as of June 2026, with employment types broken down into 83% Full Time, and 17% Part Time. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $44,219 per year, or $21.3 per hour.
Utilization Management Representative I

Utilization Management Representative I

Elevance Health

Roanoke, VA • On-site

$15.75 - $21.25/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 25 days ago

Elevance Health rating

7.8

Company rating: 7.8 out of 10

Based on 331 frontline employees who took The Breakroom Quiz

165th of 260 rated insurance

Job description

Anticipated End Date:

2026-06-08

Position Title:

Utilization Management Representative I

Job Description:

Utilization Management Representative I

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-Exempt

Workshift:

Job Family:

CUS > Care Support

Please 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.

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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

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