RN Manager II, Medical Management & Appeals (Hybrid CA/CO/NV)

Elevance Health, Inc.; Costa Mesa (CA); Hybrid; USD 102,000 - 184,000; Full time

Benefits offered by this job

Hybrid work model

Comprehensive benefits package

401(k) + match

Stock purchase plan

Job summary

Elevance Health, Inc. is seeking a Manager II Medical Management, Grievance and Appeals CA RN. The role leads clinicians to optimize member outcomes, benefits utilization, and resource use. Hybrid in-office three days per week with on-call rotation and federal holiday coverage.

Ideal candidates hold an active California RN license, have acute care and management experience, and demonstrate strong communication and leadership abilities to guide care decisions within a major health plan.

Qualifications

• Requires HS diploma or equivalent with 5 years acute care clinical experience including 2 years of management.
• Current, active, valid unrestricted California RN license is required.
• BS in nursing or related field preferred; strong leadership and communication skills desired.

Responsibilities

• Ensure adherence to medical policy and member benefits to deliver medically appropriate, high-quality, cost-effective care.
• Oversee authorization of inpatient/outpatient services and treatment settings per policy and industry standards.
• Coordinate care with facilities and providers for care-coordination.
• May manage appeals for services denied.
• Mentor lower-level managers and provide subject matter expertise within the department.
• Manage multiple functions with significant fiscal accountability.
• Develop and manage annual operating budget.
• Hire, train, coach, and evaluate direct reports.

Skills

Clinical leadership

Mentoring

Budget management

Team supervision

Education

HS diploma or equivalent

California RN license

BS preferred

Job description

Elevance Health, Inc. is seeking a Manager II Medical Management, Grievance and Appeals CA RN. The role leads clinicians to optimize member outcomes, benefits utilization, and resource use. Hybrid in-office three days per week with on-call rotation and federal holiday coverage.

Ideal candidates hold an active California RN license, have acute care and management experience, and demonstrate strong communication and leadership abilities to guide care decisions within a major health plan.