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Medical Management Clinician Associate (RN)
Review clinical information to ensure compliance with medical necessity guidelines for benefit plans.
Margate, Florida, United States
Junior
5 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 established procedures.
- The clinician will conduct precertification, concurrent, retrospective, and appropriateness of treatment setting reviews.
- The position may involve processing medical necessity denial determinations made by a Medical Director.
- The role requires collaboration with more senior nurses and Medical Directors for complex cases.
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.
- The successful individual will be detail-oriented and able to follow standard procedures effectively.
- Strong analytical skills are necessary to assess clinical information against medical policies and guidelines.
Medical Management Clinician Associate (RN)
Margate, Florida, United States
Registered Nurse
About Elevance Health
Elevance Health is a health insurance provider offering a range of healthcare services and insurance plans.