Remote Medical Management Clinician (RN/LPN)

Elevance Health, Inc.; Florida; Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Elevance Health, Inc. seeks a Medical Management Clinician to ensure benefits administration by reviewing clinical information and assessing medical necessity in line with policies.

You will collaborate with providers as needed, focusing on moderately complex case types and acting under guidance from senior staff. This role is based in Florida with a virtual-first schedule and required in-person training sessions.

Qualifications

• Requires HS diploma or equivalent.
• Minimum of 4 years of clinical experience and/or utilization review.
• Current active RN or LPN/LVN license in applicable state.
• Multi-state licensure may be required if providing services in multiple states.

Responsibilities

• Moderately complex cases may require evaluation of multiple variables against guidelines.
• Reviews may use algorithmic or automated processes.
• Handles moderately complex benefit plans and/or contracts.
• May educate members about plan benefits and physicians.

Skills

Clinical experience

Utilization review

RN/LPN license

Education

HS Diploma or equivalent

Job description

Elevance Health, Inc. seeks a Medical Management Clinician to ensure benefits administration by reviewing clinical information and assessing medical necessity in line with policies.

You will collaborate with providers as needed, focusing on moderately complex case types and acting under guidance from senior staff. This role is based in Florida with a virtual-first schedule and required in-person training sessions.