Senior Medical Management Clinician - Remote VA

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

Job summary

Elevance Health is seeking a Medical Management Clinician Senior to support complex utilization reviews in Virginia. The role can be virtual full-time with required in-person training sessions, offering flexibility and autonomy while ensuring onboarding and skill development.

You will review clinical information, assess medical necessity, collaborate with physicians, and mentor junior staff. A valid RN/LPN license and 6+ years of clinical/utilization review experience are required, with

Qualifications

• Requires 6+ years of clinical experience and/or utilization review experience.
• Active, valid RN/LPN license within applicable state(s) or territory.
• Multi-state licensure required if providing services in multiple states.

Responsibilities

• Review clinical information and assess medical necessity under guidelines/policies.
• Collaborate with physicians and healthcare providers.
• Serve as a resource for junior clinicians and staff.
• Conduct pre-certification, concurrent, retrospective, and other reviews per policies and department guidelines.
• Assist leadership with process improvement initiatives.

Skills

Clinical experience

Utilization review

RN/LPN license

Multi-state licensure

Education

High school diploma

High school diploma or equivalent

Job description

Elevance Health is seeking a Medical Management Clinician Senior to support complex utilization reviews in Virginia. The role can be virtual full-time with required in-person training sessions, offering flexibility and autonomy while ensuring onboarding and skill development.

You will review clinical information, assess medical necessity, collaborate with physicians, and mentor junior staff. A valid RN/LPN license and 6+ years of clinical/utilization review experience are required, with