Medical Management Clinician Associate

🔥 6 minutes ago

🏄 California, New York – Remote

🏄 California – Remote 🗽 New York – Remote

💵 $28 - $42 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Ensure appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or medical policies • Confirm medical services are appropriate based on assigned benefit plans, medical policies, clinical guidelines, plan benefits, and/or scripted algorithms within scope of licensure • Conduct and potentially approve precertification, concurrent, retrospective, out-of-network, and/or appropriateness of treatment setting reviews • Assess clinical information against medical policies, clinical guidelines, and relevant benefit plans/contracts • Process medical necessity denial determinations made by a Medical Director • Refer complex or non-routine reviews to more senior nurses and/or Medical Directors • Handle less complex benefit plans and/or contracts • Work partly with algorithmic or automated processes

🎯 Requirements

• H.S. diploma or equivalent • Minimum of 2 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 • Multi-state licensure required if providing services in multiple states • Candidates must be within a reasonable commuting distance from the posting location(s), unless accommodation is granted as required by law • COVID-19 and Influenza vaccination required for certain patient/member-facing roles unless an acceptable explanation is provided

🏖️ Benefits

• Comprehensive benefits package • Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical insurance • Dental insurance • Vision insurance • Short-term disability benefits • Long-term disability benefits • 401(k) with match • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Virtual full-time work arrangement • Required in-person training sessions when indicated • COVID-19 and Influenza vaccination support/requirement for certain patient/member-facing roles