Manager I – Medical Management
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Brentwood • Tennessee • Texas • United States
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About the role
- manage a team of clinicians charged with promoting quality member outcomes
- optimize member benefits
- promote effective use of resources
- ensures adherence to medical policy and member benefits in providing medically appropriate service
- authorizing inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services
- appropriateness of treatment setting by utilizing applicable medical policy and industry standards
- steering members to appropriate providers, programs or community resources
- applies clinical knowledge to work with facilities and providers for care-coordination
- managing appeals for services denied
- hiring, training, coaching, counseling, and evaluating performance of direct reports
Requirements
- Requires a HS diploma or equivalent
- minimum of 5 years acute care clinical experience
- current, active, valid unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
acute care clinical experiencecare-coordinationmedical policy adherencetreatment setting appropriatenessinpatient admissions authorizationoutpatient services authorizationsurgical procedure authorizationdiagnostic procedure authorizationappeals management
Soft Skills
team managementcoachingcounselingperformance evaluationresource optimizationcommunicationleadership
Certifications
RN license