Senior Manager, Medical Management & Appeals - RN

Elevance Health, Inc.; United States; Hybrid; USD 102,000 - 184,000; Full time

Job summary

Elevance Health is seeking a Manager II Medical Management, Grievance and Appeals in California, Colorado, or Nevada. The hybrid role requires in-office 3 days per week with flexibility; hours are 8:30–5 PST, with on-call Saturdays and holiday coverage.

You will lead a team of clinicians to promote quality member outcomes, optimize benefits, and steward resources. Responsibilities include policy adherence, care coordination, and potential appeals.

Qualifications

• Requires HS diploma or equivalent with 5 years acute care clinical experience including 2 years in management.
• Current, active, valid unrestricted California RN license is required.

Responsibilities

• Ensures adherence to medical policy and member benefits in providing medically appropriate, high-quality, cost-effective care.
• Manages areas including inpatient admissions, outpatient services, and appropriateness of treatment settings using medical policy and industry standards.
• Applies clinical knowledge to work with facilities and providers for care coordination.
• May manage appeals for services denied.
• Mentors lower leveled managers and serves as subject matter expert.
• Manages annual operating budget and fiscal accountability.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Skills

Leadership

Mentoring

Budget management

Policy interpretation

Care coordination

Education

California RN license

Job description

Elevance Health is seeking a Manager II Medical Management, Grievance and Appeals in California, Colorado, or Nevada. The hybrid role requires in-office 3 days per week with flexibility; hours are 8:30–5 PST, with on-call Saturdays and holiday coverage.

You will lead a team of clinicians to promote quality member outcomes, optimize benefits, and steward resources. Responsibilities include policy adherence, care coordination, and potential appeals.