Remote Utilization Review Clinician – RN/LPN

Elevance Health, Inc.; Latham (NY); A distancia; USD 39.000 - 48.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health benefits

Descripción de la vacante

Elevance Health, Inc. invites applications for a Medical Management Clinician Associate working primarily in a virtual capacity. The role requires an active RN/LPN license and at least 2 years of clinical or utilization review experience, with in-person training as needed.

The position centers on ensuring appropriate, evidence-based reviews of plan benefits and medical necessity. The role involves navigating algorithms, handling less complex contracts, and performing precertification and related

Formación

• Requires HS diploma or equivalent.
• Requires minimum 2 years clinical or utilization review experience.
• Active RN/LPN license or other eligible health professional licensure in applicable states.

Responsabilidades

• Confirms medical services are appropriate based on benefit plan, policies and guidelines.
• Work may be facilitated by algorithmic or automated processes.
• Handles less complex benefit plans and/or contracts.
• Conducts and may approve precertification, concurrent, retrospective, and/or appropriateness reviews.
• May process a medical necessity denial determination.
• Refers complex or non-routine reviews to more senior nurses and/or Medical Directors.

Conocimientos

Clinical experience

Utilization review experience

RN/LPN license

Educación

HS diploma or equivalent

Descripción del empleo

Elevance Health, Inc. invites applications for a Medical Management Clinician Associate working primarily in a virtual capacity. The role requires an active RN/LPN license and at least 2 years of clinical or utilization review experience, with in-person training as needed.

The position centers on ensuring appropriate, evidence-based reviews of plan benefits and medical necessity. The role involves navigating algorithms, handling less complex contracts, and performing precertification and related