Senior Medical Management Clinician

🕒 November 1

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $31 - $57 / hour

⏰ Full Time

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Open for 13 days.
• Jobs at this company usually fill in 21 days.
• Reposted once.

Apply Now

Check your resume score

Customize resume + cover letter

Find Similar Remote Jobs

☆ Save☑️ Mark as applied❌ Hide

Report problem

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

• Review clinical information and assess medical necessity under relevant guidelines and medical policies • Ensure appropriate and consistent administration of plan benefits • Handle complex cases requiring evaluation of multiple variables against guidelines • Serve as a resource to lower-level clinicians and staff • Collaborate with leadership on process improvement initiatives for utilization reviews • Assess and apply medical policies and clinical guidelines within scope of licensure • Conduct and may approve pre-certification, concurrent, retrospective, out-of-network, and treatment-setting appropriateness reviews • Process medical necessity denial determinations made by a Medical Director • Develop and foster relationships with physicians, healthcare providers, and internal and external customers • Refer complex or unclear reviews to higher-level nurses and/or Medical Directors • Collaborate with leadership to enhance training and orientation materials • Help train lower-level clinician staff

🎯 Requirements

• High school diploma or equivalent • 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 • Multi-state licensure required when providing services in multiple states • Virginia residency preferred • RN license in the state where the applicant resides highly preferred • Prior LTSS experience highly preferred • Ability to work Monday through Friday, 8am to 5pm EST • COVID-19 and Influenza vaccination may be required for certain patient/member-facing roles

🏖️ Benefits

• Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401(k) contribution and match • Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical, dental, and vision benefits • Short- and long-term disability benefits • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Overtime opportunity if desired

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume