Senior Medical Management Clinician - Remote RN/LPN

Elevance Health, Inc.; Roanoke (VA); A distancia; USD 43.000 - 79.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Benefits package

401(k) match

Stock purchase plan

Descripción de la vacante

Elevance Health seeks a Medical Management Clinician Senior in Virginia to review clinical information and assess medical necessity under guidelines. The role may involve collaboration with physicians and other clinicians, focusing on complex cases and serving as a resource for junior staff.

The position emphasizes RN/LPN licensure, utilization review expertise, and multi-state licensure where applicable, with hybrid/remote work options and in-person training requirements as needed.

Formación

• Requires H.S. diploma or equivalent.
• Requires a minimum of 6 years of clinical experience and/or utilization review experience.
• Current active, valid and unrestricted LPN/LVN or RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required; or any combination of education and experience which would provide an equivalent background.
• Multi-state licensure is required if this individual is providing services in multiple states.

Responsabilidades

• Responsible for complex reviews that may require evaluation of multiple variables against guidelines when procedures are not clear.
• Serves as a resource to lower-level clinicians and staff.
• May collaborate with leadership to assist in process improvement initiatives for utilization reviews.
• Assess and apply medical policies and clinical guidelines within scope of licensure.
• Conducts and may approve pre-certification, concurrent, retrospective, out of network reviews by utilizing medical policies and guidelines.
• Develops and fosters ongoing relationships with physicians, healthcare service providers and internal and external customers to help improve health outcomes for members.
• Refer complex or unclear reviews to higher level nurses and/or Medical Directors.
• Collaborates with leadership in training materials and process improvements.

Conocimientos

Clinical experience

Utilization review

Educación

High school diploma

Descripción del empleo

Elevance Health seeks a Medical Management Clinician Senior in Virginia to review clinical information and assess medical necessity under guidelines. The role may involve collaboration with physicians and other clinicians, focusing on complex cases and serving as a resource for junior staff.

The position emphasizes RN/LPN licensure, utilization review expertise, and multi-state licensure where applicable, with hybrid/remote work options and in-person training requirements as needed.