Manager II, Medical Management & Appeals – Hybrid RN (CA)

Elevance Health, Inc.; Los Angeles (CA); Híbrido; USD 102.000 - 184.000; Jornada completa

Descripción de la vacante

Elevance Health is hiring a Manager II for Medical Management, Grievance and Appeals. The role requires active California RN licensure, at least five years in acute care with a minimum of two years in management, and a track record in care coordination within a health plan environment.

The position is hybrid, based in California, Colorado, or Nevada, with on-call rotation and occasional weekend coverage. Strong leadership and budget responsibilities are expected.

Formación

• Requires HS diploma or equivalent and a minimum of 5 years acute care clinical experience which includes a minimum of 2 years prior management experience; or any combination of education and experience, which would provide an equivalent background. Current, active, valid unrestricted California RN license is required.

Responsabilidades

• Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective.
• Manages areas which may include authorizing inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.
• Applies clinical knowledge to work with facilities and providers for care-coordination.
• May also manage appeals for services denied.
• Serves as mentor to lower leveled managers and as subject matter expert for other areas of the company and within the department.
• Manages multiple functions requiring unique sets of knowledge or has significant fiscal accountability.
• Develops and manages annual operating budget.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Conocimientos

RN license

management experience

acute care nursing

DMHC experience preferred

Educación

HS diploma or equivalent

California RN license

Descripción del empleo

Elevance Health is hiring a Manager II for Medical Management, Grievance and Appeals. The role requires active California RN licensure, at least five years in acute care with a minimum of two years in management, and a track record in care coordination within a health plan environment.

The position is hybrid, based in California, Colorado, or Nevada, with on-call rotation and occasional weekend coverage. Strong leadership and budget responsibilities are expected.