Medical Management Clinician Associate

Elevance Health

Medical Management Clinician Associate at Elevance Health ensuring appropriate administration of plan benefits. Role involves reviewing clinical info and assessing medical necessity under relevant guidelines.

Posted 7/1/2026full-timeTampa • Florida • 🇺🇸 United StatesJuniorMid-LevelWebsite

About the role

Key responsibilities & impact

Confirms medical services are appropriate based on assigned benefit plan, medical policies, clinical guidelines, plan benefits, and/or scripted algorithms within scope of licensure.
Work may be facilitated, in part, by algorithmic or automated processes.
Handles less complex benefit plans and/or contracts.
Conducts 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.
May process a medical necessity denial determination made by a Medical Director.
Refers complex or non-routine reviews to more senior nurses and/or Medical Directors.

Requirements

What you’ll need

Requires H.S. diploma or equivalent.
Requires a minimum of 2 years of clinical experience and/or utilization review experience.
Current active, valid and unrestricted LPN/LVN or RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required.
Multi-state licensure is required if this individual is providing services in multiple states.
LTSS or Utilization Management experience strongly preferred.

Benefits

Comp & perks

Paid Time Off
medical, dental, vision, short and long term disability benefits
401(k) + match
stock purchase plan
life insurance
wellness programs and financial education resources

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Medical Policy AssessmentClinical Guideline ApplicationPrecertification ReviewConcurrent ReviewRetrospective ReviewOut-of-Network ReviewMedical Necessity DeterminationAlgorithmic Process Facilitation