Medical Management Clinician

Medical Management Clinician - Licensed Nurse

Locations:
Tampa, FL & Miami, FL

Hybrid 1:
This role requires associates to be in-office 1‑2 days a month, fostering collaboration and connectivity while providing flexibility to support productivity and work‑life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Please note that per our 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.

Schedule:

Monday – Friday, 8:00AM – 5:00PM Eastern Time

• Review moderate‑complex cases and evaluate multiple variables against guidelines when procedures are not clear.
• Work with algorithmic or automated processes to facilitate reviews.
• Handle moderately complex benefit plans and/or contracts.
• Perform reviews that may require guidance by more senior colleagues and/or management.
• Serve as a resource to less experienced staff.
• Conduct 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.
• Process medical necessity denial determinations made by a Medical Director.
• Work directly with healthcare providers to obtain and understand clinical information.
• Refer complex or unclear reviews to higher‑level nurses and/or Medical Directors.
• Educate members about plan benefits and physicians.
• Do not issue medical necessity non‑certifications.

• High school diploma or equivalent.
• Minimum of 4years of clinical experience and/or utilization review experience.
• Current active, valid and unrestricted LPN/LVN license, RN license, 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 if providing services in multiple states.

• Strong critical thinking and multitasking skills.
• Proficiency in Microsoft Office products.

Job Level: Non‑Management, Non‑Exempt

Workshift:
Not specified

Job Family: MED >
Licensed Nurse

Elevance Health offers a range of market‑competitive total rewards that include merit increases, paid holidays, paid time off, 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.

Elevance Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.