Remote Medical Management Clinician – Utilization Review

Elevance Health; Costa Mesa (CA); Remote; USD 39,000 - 59,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive programs

401(k) + match

Stock purchase plan

Wellness programs

Job summary

Elevance Health is seeking a Medical Management Clinician Associate to ensure accurate and consistent administration of plan benefits. You will review clinical information and assess medical necessity under guidelines, policies, and contracts, in a virtual full-time role with in-person training as needed.

The position requires a HS diploma, 2 years of clinical or utilization review experience, and an active RN/LPN license in the United States.

Qualifications

• Requires 2 years of clinical experience and/or utilization review experience.
• Active RN/LPN license in applicable state(s) or territory of the United States required.
• Multi-state licensure required if providing services in multiple states.

Responsibilities

• Confirms medical services are appropriate based on benefit plan, policies, guidelines and contracts.
• Assesses clinical information against medical policies for precertification and reviews.
• May process a medical necessity denial determination by a Medical Director.
• Refers complex reviews to senior nurses or Medical Directors.

Skills

Clinical experience

Utilization review

Education

HS Diploma or equivalent

RN/LPN license in good standing

Job description

Elevance Health is seeking a Medical Management Clinician Associate to ensure accurate and consistent administration of plan benefits. You will review clinical information and assess medical necessity under guidelines, policies, and contracts, in a virtual full-time role with in-person training as needed.

The position requires a HS diploma, 2 years of clinical or utilization review experience, and an active RN/LPN license in the United States.