Medical Management Clinician Associate

Elevance Health; Latham (NY); Remote; USD 39,000 - 59,000; Full time

Job summary

Elevance Health, Inc. is seeking a Medical Management Clinician Associate for a virtual role based in New York. You will review clinical information to determine medical necessity and ensure benefits are administered correctly.

Training may require in-person sessions, with full-time remote work supported by robust onboarding. This position requires an active LPN/LVN or RN license and at least two years of clinical or utilization review experience.

Qualifications

• Requires minimum 2 years of clinical experience and/or utilization review experience.
• Active license as LPN/LVN or RN in applicable states is required.

Responsibilities

• Confirms medical services are appropriate based on benefit plan, medical policies, and guidelines.
• May use algorithmic or automated processes to support reviews.
• Conducts precertification, concurrent, retrospective and appropriateness of setting reviews.
• Refers complex cases to senior nurses or Medical Directors.

Skills

Clinical experience

Utilization review

Education

High School diploma

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.

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

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 considered to be 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.