Senior Medical Management Clinician — Remote RN

Elevance Health, Inc.; Ashburn (VA); Hybrid; USD 43,000 - 79,000; Full time

Benefits offered by this job

Benefits package

Incentive programs

Equity stock purchase

401(k) contribution

Job summary

Elevance Health is seeking a Medical Management Clinician Senior in Virginia to review clinical information, assess medical necessity, and collaborate with physicians to ensure appropriate benefit utilization. The role supports hybrid/virtual work with mandatory in-person training sessions and occasional travel for onboarding.

Ideal candidates hold an active RN/LPN license, have 6 years of clinical or utilization review experience, and may hold multi-state licensure.

Qualifications

• Requires 6 years of clinical experience and/or utilization review experience.
• Active LPN/LVN or RN license to practice as a health professional in applicable state(s).
• Multi-state licensure is required if providing services in multiple states.

Responsibilities

• Review clinical information and assess medical necessity under guidelines/policies.
• Collaborate with physicians and healthcare providers.
• Conduct pre-certification, concurrent, retrospective reviews following policies.

Skills

Clinical experience

Utilization review

Collaboration

Education

LPN/LVN or RN license

Job description

Elevance Health is seeking a Medical Management Clinician Senior in Virginia to review clinical information, assess medical necessity, and collaborate with physicians to ensure appropriate benefit utilization. The role supports hybrid/virtual work with mandatory in-person training sessions and occasional travel for onboarding.

Ideal candidates hold an active RN/LPN license, have 6 years of clinical or utilization review experience, and may hold multi-state licensure.