Senior Medical Management Clinician — Remote RN/LPN

Elevance Health, Inc.; Oregon; Hybrid; USD 43,000 - 79,000; Full time

Job summary

Elevance Health is seeking a Medical Management Clinician Senior to ensure appropriate administration of plan benefits by reviewing clinical information and assessing medical necessity under guidelines and policies. The role may collaborate with providers and serves as a resource for junior clinicians.

The position is located in Virginia with virtual full-time work and required in-person training sessions. Schedule is Monday–Friday, 8am–5pm EST, with overtime opportunities.

Qualifications

• Requires HS diploma or equivalent.
• Minimum 6 years of clinical experience and/or utilization review experience.
• Current active, valid RN/LPN license and/or certification to practice as a health professional within licensure scope; multi-state licensure required if providing services in multiple states.

Responsibilities

• Review clinical information to assess medical necessity.
• Collaborate with physicians and healthcare providers.
• Serve as a resource for junior Clinicians and staff.
• Conduct pre-certification, concurrent, retrospective, and appropriateness of treatment reviews per policies.
• Develop relationships with providers to improve health outcomes.

Skills

Clinical experience

Utilization review

Multi-state licensure

Education

High school diploma

Job description

Elevance Health is seeking a Medical Management Clinician Senior to ensure appropriate administration of plan benefits by reviewing clinical information and assessing medical necessity under guidelines and policies. The role may collaborate with providers and serves as a resource for junior clinicians.

The position is located in Virginia with virtual full-time work and required in-person training sessions. Schedule is Monday–Friday, 8am–5pm EST, with overtime opportunities.