Remote Medical Management Clinician (RN Preferred)

Elevance Health, Inc.; Tampa (FL); Remote; USD 70,000 - 95,000; Full time

Job summary

Elevance Health, Inc. seeks a Medical Management Clinician based in Florida to support virtual work with required in-person training sessions. This role emphasizes flexibility and autonomy while ensuring onboarding and skill development.

You will review clinical information to determine medical necessity under guidelines, collaborate with providers, and manage moderately complex cases. Requires HS diploma, 4+ years clinical/utilization review experience, and active RN/LPN license with

Qualifications

• Requires HS diploma or equivalent.
• Requires a minimum of 4 years of clinical experience and/or utilization review experience.
• Current active, valid and unrestricted RN/LPN 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.

Responsibilities

• Moderately complex case reviews comparing variables against guidelines and policies.
• Collaborate with healthcare providers to obtain clinical information.
• Conducts precertification, concurrent, retrospective, and other reviews by assessing clinical information against policies and benefit plans.
• May escalate complex reviews to senior staff or Medical Directors.
• Educates members about plan benefits and physicians where appropriate.

Skills

Clinical experience

Utilization review

Multistate licensure

Education

High School diploma

RN/LPN license

Job description

Elevance Health, Inc. seeks a Medical Management Clinician based in Florida to support virtual work with required in-person training sessions. This role emphasizes flexibility and autonomy while ensuring onboarding and skill development.

You will review clinical information to determine medical necessity under guidelines, collaborate with providers, and manage moderately complex cases. Requires HS diploma, 4+ years clinical/utilization review experience, and active RN/LPN license with