Medical Management Clinician Senior -Licensed Nurse

Position Title Medical Management Clinician Senior - Licensed Nurse Location Tampa, FL & Miami, FL (Hybrid/Virtual with required in‑person training) Job End Date 2026-08-03 Responsibilities Assess and manage complex medical cases, evaluating multiple variables against guidelines when procedures are unclear. Act as a resource for lower‑level clinicians and staff. Collaborate with leadership to improve utilization review processes and increase efficiency. Apply medical policies and clinical guidelines within scope of licensure. Conduct and, when appropriate, approve pre‑certification, concurrent, retrospective, out‑of‑network, and treatment‑setting appropriateness reviews. Process medical necessity denial determinations with Medical Director guidance. Develop and maintain relationships with physicians, healthcare providers, and internal and external customers to improve member health outcomes. Refer unclear or complex reviews to higher‑level nurses or Medical Directors. Educate members about plan benefits and physician services. Do not issue medical necessity non‑certifications. Enhance training and orientation materials in partnership with leadership. Complete quality audits and assist management with corrective action plans. Support leadership and stakeholders on process improvement initiatives. Assist in training lower‑level clinician staff. Qualifications 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 (or equivalent certification) to practice within scope in applicable state(s). Multi‑state licensure required if providing services in multiple states. Compensation and Benefits Competitive salary and comprehensive benefits package, including health, dental, vision, short and long‑term disability, 401(k) with company match, stock purchase plan, life insurance, wellness programs, paid holidays, paid time off, and incentive bonus programs (unless covered by a collective bargaining agreement). EEO Statement 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 federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form. #J-18808-Ljbffr The Elevance Health Companies, Inc.