Medical Management Clinician Associate

Elevance Health, Inc.; Latham (NY); Remote; USD 39,000 - 48,000; Full time

Benefits offered by this job

Health benefits

Job summary

Elevance Health, Inc. invites applications for a Medical Management Clinician Associate working primarily in a virtual capacity. The role requires an active RN/LPN license and at least 2 years of clinical or utilization review experience, with in-person training as needed.

The position centers on ensuring appropriate, evidence-based reviews of plan benefits and medical necessity. The role involves navigating algorithms, handling less complex contracts, and performing precertification and related

Qualifications

• Requires HS diploma or equivalent.
• Requires minimum 2 years clinical or utilization review experience.
• Active RN/LPN license or other eligible health professional licensure in applicable states.

Responsibilities

• Confirms medical services are appropriate based on benefit plan, policies and guidelines.
• 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/or appropriateness reviews.
• May process a medical necessity denial determination.
• Refers complex or non-routine reviews to more senior nurses and/or Medical Directors.

Skills

Clinical experience

Utilization review experience

RN/LPN license

Education

HS diploma or equivalent

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 - $35.08

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.