Manager II Medical Management, Grievance and Appeals CA RN required

Elevance Health, Inc.; United States; Hybrid; USD 102.000 - 184.000; Vollzeit

Zusammenfassung

Elevance Health is seeking a Manager II Medical Management, Grievance and Appeals in California, Colorado, or Nevada. The hybrid role requires in-office 3 days per week with flexibility; hours are 8:30–5 PST, with on-call Saturdays and holiday coverage.

You will lead a team of clinicians to promote quality member outcomes, optimize benefits, and steward resources. Responsibilities include policy adherence, care coordination, and potential appeals.

Qualifikationen

• Requires HS diploma or equivalent with 5 years acute care clinical experience including 2 years in management.
• Current, active, valid unrestricted California RN license is required.

Aufgaben

• Ensures adherence to medical policy and member benefits in providing medically appropriate, high-quality, cost-effective care.
• Manages areas including inpatient admissions, outpatient services, and appropriateness of treatment settings using medical policy and industry standards.
• Applies clinical knowledge to work with facilities and providers for care coordination.
• May manage appeals for services denied.
• Mentors lower leveled managers and serves as subject matter expert.
• Manages annual operating budget and fiscal accountability.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Kenntnisse

Leadership

Mentoring

Budget management

Policy interpretation

Care coordination

Ausbildung

California RN license

Jobbeschreibung

Manager II Medical Management, Grievance and Appeals CA RN required

Anticipated job Posting End Date: 11/13/2026

Location

California, Colorado, or Nevada

Hybrid 2: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

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 accommodation is granted as required by law.

Work Hours: Monday – Friday 8:30-5 PST. This job does require on call coverage in rotation for Saturday’s, usually 1 Saturday 8:30-5 PST every 4 weeks, as well as federal holiday coverage. Flexibility required for appropriate team coverage as needed.

The Manager II Medical Management is responsible to manage a team of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources.

How you will make an impact

• 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.

Minimum Qualifications

• Requires a 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.

Preferred Skills, Capabilities and Experiences

• BS preferred.
• Trauma or ER clinical nursing experience is strongly preferred.
• Fast paced production environment, oversight of inventory management experience strongly preferred.
• Previous health plan experience strongly preferred.
• California Department of Managed Health Care (DMHC) experience preferred.
• Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $102,400 to $184,320

• Location(s): California, Colorado, Nevada

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

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 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.