Remote Utilization Review Clinician – Medical Management

Elevance Health, Inc.; Florida; Hybrid; USD 55,000 - 85,000; Full time

Benefits offered by this job

Hybrid/Remote work

In-person training sessions

Job summary

Elevance Health, Inc. is seeking a Medical Management Clinician Associate to review clinical information and assess medical necessity under applicable guidelines and policies. This role focuses on less complex, high-volume benefit plans and follows standard procedures that do not require RN-level training.

The position offers virtual work with required in-person training sessions. Candidates must have 2+ years of clinical or utilization review experience and a valid RN or LPN license, with

Qualifications

• Requires 2 years of clinical experience and/or utilization review experience.
• Active, valid RN or LPN license to practice in applicable state(s).
• Multi-state licensure required for service in multiple states.
• Requires HS diploma or equivalent.

Responsibilities

• Reviews clinical information and assesses medical necessity within guidelines and policies.
• Ensures appropriate administration of plan benefits for less complex, high-volume cases.
• Performs precertification, concurrent, retrospective reviews per policy.
• May handle approvals within scope of licensure and refer complex cases as needed.
• Supports documentation and adherence to clinical policies and contracts.
• Contributes to team decisions and maintains compliance with licensure requirements.

Skills

Clinical experience

Nursing license

Multistate licensure

HS diploma

Education

High School Diploma or equivalent

Job description

Elevance Health, Inc. is seeking a Medical Management Clinician Associate to review clinical information and assess medical necessity under applicable guidelines and policies. This role focuses on less complex, high-volume benefit plans and follows standard procedures that do not require RN-level training.

The position offers virtual work with required in-person training sessions. Candidates must have 2+ years of clinical or utilization review experience and a valid RN or LPN license, with