Remote Medical Management Clinician (RN/LPN)

Elevance Health; Tampa (FL); Remote; USD 65,000 - 90,000; Full time

Job summary

Elevance Health is seeking a Medical Management Clinician to join our remote team in Florida. This full-time role supports members by reviewing clinical information and determining medical necessity under policy guidelines.

Candidates must have a high school diploma and at least four years of clinical or utilization review experience, plus an active RN/LPN/LVN license valid in the US. Multi-state licensure is required if serving multiple states.

Qualifications

• HS diploma or equivalent is required.
• Minimum of 4 years of clinical experience and/or utilization review experience.
• Active, valid, unrestricted LPN/LVN or RN license to practice in applicable US states; multi-state licensure if serving multiple states.

Responsibilities

• Review clinical information to determine medical necessity according to guidelines and policies.
• Collaborate with healthcare providers as part of case reviews.
• Handle moderately complex benefit reviews and communicate decisions to members.

Skills

RN license

Education

High school diploma or equivalent

Job description

Elevance Health is seeking a Medical Management Clinician to join our remote team in Florida. This full-time role supports members by reviewing clinical information and determining medical necessity under policy guidelines.

Candidates must have a high school diploma and at least four years of clinical or utilization review experience, plus an active RN/LPN/LVN license valid in the US. Multi-state licensure is required if serving multiple states.