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Medical Management Clinician Associate (RN)
Review clinical information to determine medical necessity for various benefit plans.
New York
Junior
$29.68-$44.52 USD per hour
3 days ago
Elevance Health
Elevance Health is a health insurance provider offering a range of healthcare services and insurance plans.
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✨ About The Role
- The Medical Management Clinician Associate (RN) will review clinical information to ensure appropriate administration of plan benefits.
- This role focuses on less complex benefit plans and contracts, following standard procedures.
- Responsibilities include conducting precertification and concurrent reviews, as well as assessing medical necessity.
- The position may involve processing medical necessity denial determinations made by a Medical Director.
- The role requires referring complex cases to more senior nurses or Medical Directors for further review.
âš¡ Requirements
- The ideal candidate will have at least 2 years of clinical experience or utilization review experience.
- A current active, valid, and unrestricted RN license is required for this position.
- Candidates with an Associate's degree or BSN are highly preferred.
- Strong analytical skills are essential for assessing clinical information against medical policies and guidelines.
- The successful individual will be comfortable working in a hybrid environment, balancing remote work with in-office collaboration.
Medical Management Clinician Associate (RN)
New York
$29.68-$44.52 USD per hour
Registered Nurse
About Elevance Health
Elevance Health is a health insurance provider offering a range of healthcare services and insurance plans.