Elevance Health
Medical Management Clinician Associate – 40 hours, 4-5 days/week, Saturdays and
Elevance Health, Mason, Ohio, United States, 45040
Overview
Medical Management Clinician Associate – 40 hours, 4-5 days/week, Saturdays and Sundays. Location: This role enables associates to work virtually full-time, with the exception of required in person training sessions, providing maximum flexibility and autonomy. Alternate locations may be considered. Shift: This position is a 40 hour work week. Saturdays and Sundays are required along with 2 – 3 other weekdays – same schedule each week. Daily shifts may be 12 hrs, 10 hours, or 8 hours. Join to apply for the Medical Management Clinician Associate – 40 hours, 4-5 days/week, Saturdays and Sundays role at Elevance Health. Note: Per policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment unless an accommodation is granted as required by law.
Responsibilities
Confirms medical services are appropriate based on assigned benefit plan, medical policies, clinical guidelines, plan benefits, and/or scripted algorithms within scope of licensure.
Work may be facilitated, in part, by algorithmic or automated processes.
Handles less complex benefit plans and/or contracts.
Conducts and may approve precertification, concurrent, retrospective, out-of-network, and/or appropriateness of treatment setting reviews by assessing clinical information against appropriate medical policies, clinical guidelines, and the relevant benefit plan/contract.
May process a medical necessity denial determination made by a Medical Director.
Refers complex or non-routine reviews to more senior nurses and/or Medical Directors.
Does not issue medical necessity non-certifications.
Minimum Requirements
Requires H.S. diploma or equivalent.
Requires a 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 the state of residence.
Compact LPN/LVN or RN license, or ability to obtain compact license prior to start date is required.
Preferred Skills, Capabilities & Experiences
Experience with Prior Authorization preferred.
Strong typing skills preferred.
Pay Range $25.96-$30.84 hourly
Additional Information Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
About Elevance Health Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
Work Philosophy and Benefits We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Work Arrangement Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
COVID-19 & EEO The health of our associates and communities is a top priority. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer may be rescinded unless you provide an acceptable explanation. We will follow all relevant federal, state, and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all applicable laws.
Seniority level
Entry level
Employment type
Full-time
Job function
Health Care Provider
Industries
Hospitals and Health Care
#J-18808-Ljbffr
Medical Management Clinician Associate – 40 hours, 4-5 days/week, Saturdays and Sundays. Location: This role enables associates to work virtually full-time, with the exception of required in person training sessions, providing maximum flexibility and autonomy. Alternate locations may be considered. Shift: This position is a 40 hour work week. Saturdays and Sundays are required along with 2 – 3 other weekdays – same schedule each week. Daily shifts may be 12 hrs, 10 hours, or 8 hours. Join to apply for the Medical Management Clinician Associate – 40 hours, 4-5 days/week, Saturdays and Sundays role at Elevance Health. Note: Per policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment unless an accommodation is granted as required by law.
Responsibilities
Confirms medical services are appropriate based on assigned benefit plan, medical policies, clinical guidelines, plan benefits, and/or scripted algorithms within scope of licensure.
Work may be facilitated, in part, by algorithmic or automated processes.
Handles less complex benefit plans and/or contracts.
Conducts and may approve precertification, concurrent, retrospective, out-of-network, and/or appropriateness of treatment setting reviews by assessing clinical information against appropriate medical policies, clinical guidelines, and the relevant benefit plan/contract.
May process a medical necessity denial determination made by a Medical Director.
Refers complex or non-routine reviews to more senior nurses and/or Medical Directors.
Does not issue medical necessity non-certifications.
Minimum Requirements
Requires H.S. diploma or equivalent.
Requires a 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 the state of residence.
Compact LPN/LVN or RN license, or ability to obtain compact license prior to start date is required.
Preferred Skills, Capabilities & Experiences
Experience with Prior Authorization preferred.
Strong typing skills preferred.
Pay Range $25.96-$30.84 hourly
Additional Information Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
About Elevance Health Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
Work Philosophy and Benefits We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Work Arrangement Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
COVID-19 & EEO The health of our associates and communities is a top priority. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer may be rescinded unless you provide an acceptable explanation. We will follow all relevant federal, state, and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all applicable laws.
Seniority level
Entry level
Employment type
Full-time
Job function
Health Care Provider
Industries
Hospitals and Health Care
#J-18808-Ljbffr