Medical Management Clinician Associate-Licensed Nurse

Location: Tampa, FL or Miami, FL. The Medical Management Clinician Associate role is available for full‑time work, with flexibility for virtual work except for required in‑person training sessions. The candidate must be within reasonable commuting distance to the posting location unless accommodations are provided. The Medical Management Clinician Associate is responsible for ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or medical policies. The focus is on less complex benefit plans and/or higher volume contracts, following standard procedures that do not require registration nurse skill. How You Will Make An Impact 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 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 High school diploma or equivalent and 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 applicable state(s) or territory of the United States. Multi‑state licensure is required if this individual provides services in multiple states. 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, and local laws. Applicants who require accommodation to participate in the job application process may contact View email address on click.appcast.io for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration. #J-18808-Ljbffr Elevance Health