Remote Utilization Review Nurse (LPN/RN) — Florida

Elevance Health (Anthem); Tampa (FL); Hybrid; USD 65,000 - 85,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) + match

Stock purchase plan

Life insurance

Paid time off

Wellness programs

Job summary

Elevance Health seeks a Medical Management Clinician Associate in Florida. The role supports virtual work with in-person training sessions, requiring residence in Florida and compliance with hybrid/virtual work policies.

License and licensure in-state are required, with multi-state licensure if serving multiple states. The position emphasizes clinical reviews, framework-based decision-making, and collaboration with Medical Directors.

Qualifications

• Requires H.S. diploma or equivalent.
• Minimum of 2 years of clinical and/or utilization review experience.
• Active, valid RN/LPN license and multi-state licensure if applicable.

Responsibilities

• Confirms medical services are appropriate based on benefit plans and policies.
• Reviews precertification, concurrent, retrospective and other reviews per policies.
• May process medical necessity denials as directed.
• Refers complex reviews to senior nurses or Medical Directors.
• Operates within licensure scope and uses scripted algorithms where applicable.
• Does not issue medical necessity non-certifications.

Skills

Clinical experience

Utilization review

LPN/LVN or RN license

Education

High School diploma or equivalent

Job description

Elevance Health seeks a Medical Management Clinician Associate in Florida. The role supports virtual work with in-person training sessions, requiring residence in Florida and compliance with hybrid/virtual work policies.

License and licensure in-state are required, with multi-state licensure if serving multiple states. The position emphasizes clinical reviews, framework-based decision-making, and collaboration with Medical Directors.