Medical Management Clinician Senior
Elevance Health(1 month ago)
About this role
The Medical Management Clinician Senior performs clinical reviews to ensure appropriate and consistent administration of plan benefits, assessing medical necessity under applicable guidelines and policies. The role supports complex case types, serves as a resource for more junior clinicians, and collaborates with internal and external stakeholders to support member health outcomes.
Required Skills
- Clinical Review
- Utilization Review
- Medical Necessity
- Case Evaluation
- Provider Collaboration
- Claims Experience
- Medical Coding
- Computer Skills
- Quality Audits
- Process Improvement
+1 more
Qualifications
- High School Diploma
- Active Unrestricted LPN/LVN License
- Active Unrestricted RN License
- Multi-State Licensure (if applicable)
About Elevance Health
elevancehealth.comElevance Health, formerly Anthem, Inc., serves people across their entire health journey taking an integrated whole-health approach.
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