Remote Utilization Review Clinician – Florida

Elevance Health, Inc.; Miami (FL); Hybrid; USD 65,000 - 75,000; Full time

Job summary

Elevance Health, Inc. is seeking a Medical Management Clinician Associate in Florida. The role is largely virtual with required in-person training sessions and occasional onsite engagements as part of a hybrid work model.

Candidates must reside in Florida and meet licensure and clinical experience requirements. The position emphasizes reviewing medical necessity, supporting benefit plan assessments, and adhering to clinical policies and guidelines.

Qualifications

• Requires HS diploma or equivalent.
• 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).
• Multi-state licensure is required if providing services in multiple states.

Responsibilities

• Reviews clinical information and assesses medical necessity under relevant guidelines and policies.
• Performs precertification, concurrent, retrospective, out-of-network reviews within scope of licensure.
• May process a medical necessity denial determination as directed by Medical Directors.
• Refers complex reviews to senior nurses and/or Medical Directors.
• Does not issue medical necessity non-certifications.

Skills

Clinical experience

Utilization review experience

Education

High school diploma or equivalent

LPN/LVN or RN license active

Multi-state licensure

Job description

Elevance Health, Inc. is seeking a Medical Management Clinician Associate in Florida. The role is largely virtual with required in-person training sessions and occasional onsite engagements as part of a hybrid work model.

Candidates must reside in Florida and meet licensure and clinical experience requirements. The position emphasizes reviewing medical necessity, supporting benefit plan assessments, and adhering to clinical policies and guidelines.