Medical Management Clinician Associate

Elevance Health (Anthem); Boght Corners (NY); Remote; USD 39,000 - 59,000; Full time

Job summary

Elevance Health seeks a Medical Management Clinician Associate to review clinical information and assess medical necessity under guidelines and policies. Location is virtual with in-person training sessions when indicated, offering flexibility and autonomy.

Applicants must have 2+ years of clinical or utilization review experience and a current active RN/LPN license. Hybrid/remote work policy applies based on commuting distance and law.

Qualifications

• Requires HS diploma or equivalent.
• Minimum 2 years of clinical experience and/or utilization review experience.
• Current active, valid and unrestricted RN/LPN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory.

Responsibilities

• Confirms medical services are appropriate based on plan, policies, guidelines, and benefits.
• Work may be facilitated by algorithmic or automated processes.
• Handles less complex benefit plans and/or contracts.
• Conducts and may approve precertification, concurrent, retrospective, and appropriateness reviews by assessing clinical information against policies and plan.
• May process a medical necessity denial determination and refer complex cases to senior staff.
• Refer complex or non-routine reviews to more senior nurses and/or Medical Directors.

Skills

Clinical experience

Utilization review

Medical policy knowledge

Education

HS Diploma or equivalent

RN/LPN license

Job description

Anticipated End Date: 2026-11-03

Position Title: Medical Management Clinician Associate

Job Description

The Medical Management Clinician Associate is responsible for ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or medical policies.

Location

Virtual - This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

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.

How you will make an impact

• Confirms medical services are appropriate based on assigned benefit plan, medical policies, clinical guidelines, plan benefits, and/or scripted algorithms within scope of licensure.
• Work may be facilitated, in part, by algorithmic or automated processes.
• Handles less complex benefit plans and/or contracts.
• Conducts and may approve precertification, concurrent, retrospective, out-of-network, and/or appropriateness of treatment setting reviews by assessing clinical information against appropriate medical policies, clinical guidelines, and the relevant benefit plan/contract.
• May process a medical necessity denial determination made by a Medical Director.
• Refers complex or non-routine reviews to more senior nurses and/or Medical Directors.

Minimum Requirements

• Requires H.S. diploma or equivalent.
• Requires a minimum of 2 years of clinical experience and/or utilization review experience.
• Current active, valid and unrestricted LPN/LVN or RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required. Multi-state licensure is required if this individual is providing services in multiple states.

Salary

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $28.44 - $42.67

Locations

New York

Benefits

• 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 between the above factors as well as market/business considerations.

Job Level

Non-Management Non-Exempt

Workshift

Job Family

MED > Licensed Nurse

Agency Policy

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