Virtual Medical Management Clinician (Utilization Review)

Elevance Health, Inc.; Latham (NY); Remote; USD 39,000 - 59,000; Full time

Job summary

Elevance Health, Inc. is seeking a Medical Management Clinician Associate for a virtual role based in New York. You will review clinical information to determine medical necessity and ensure benefits are administered correctly.

Training may require in-person sessions, with full-time remote work supported by robust onboarding. This position requires an active LPN/LVN or RN license and at least two years of clinical or utilization review experience.

Qualifications

• Requires minimum 2 years of clinical experience and/or utilization review experience.
• Active license as LPN/LVN or RN in applicable states is required.

Responsibilities

• Confirms medical services are appropriate based on benefit plan, medical policies, and guidelines.
• May use algorithmic or automated processes to support reviews.
• Conducts precertification, concurrent, retrospective and appropriateness of setting reviews.
• Refers complex cases to senior nurses or Medical Directors.

Skills

Clinical experience

Utilization review

Education

High School diploma

Job description

Elevance Health, Inc. is seeking a Medical Management Clinician Associate for a virtual role based in New York. You will review clinical information to determine medical necessity and ensure benefits are administered correctly.

Training may require in-person sessions, with full-time remote work supported by robust onboarding. This position requires an active LPN/LVN or RN license and at least two years of clinical or utilization review experience.