Medical Management Clinician Associate

Elevance Health (Anthem); Tampa (FL); Hybrid; USD 65,000 - 85,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) + match

Stock purchase plan

Life insurance

Paid time off

Wellness programs

Job summary

Elevance Health seeks a Medical Management Clinician Associate in Florida. The role supports virtual work with in-person training sessions, requiring residence in Florida and compliance with hybrid/virtual work policies.

License and licensure in-state are required, with multi-state licensure if serving multiple states. The position emphasizes clinical reviews, framework-based decision-making, and collaboration with Medical Directors.

Qualifications

• Requires H.S. diploma or equivalent.
• Minimum of 2 years of clinical and/or utilization review experience.
• Active, valid RN/LPN license and multi-state licensure if applicable.

Responsibilities

• Confirms medical services are appropriate based on benefit plans and policies.
• Reviews precertification, concurrent, retrospective and other reviews per policies.
• May process medical necessity denials as directed.
• Refers complex reviews to senior nurses or Medical Directors.
• Operates within licensure scope and uses scripted algorithms where applicable.
• Does not issue medical necessity non-certifications.

Skills

Clinical experience

Utilization review

LPN/LVN or RN license

Education

High School diploma or equivalent

Job description

Medical Management Clinician Associate

Location

Candidates are required to reside in the state of Florida. This role enables associates to work virtually full-time, except for required in-person training sessions, 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 an accommodation is granted as required by law.

Schedule

This role will work 8:00 am - 5:00 pm 4 days Monday thru Friday and 1 day on the weekend that could be Saturday or Sunday for a total of 5 day per work week.

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.
• Does not issue medical necessity non-certifications.

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.

Preferred Skills, Capabilities and Experiences

• LTSS or Utilization Management experience strongly preferred.

Job Level

Non-Management Non-Exempt

Job Family

MED > Licensed Nurse

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/m