Medical Management Clinician Associate – Licensed Nurse

Elevance Health

Medical Management Clinician Associate managing plan benefits for healthcare services at Elevance Health. Validating medical necessity and compliance for less complex benefit plans in a virtual role.

Posted 7/8/2026full-timeTampa • Florida • 🇺🇸 United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical assessment and utilization review, ensuring compliance with medical policies and benefit plans. Proficient in handling precertification and treatment setting reviews while maintaining active licensure in applicable states.

Highest-signal resume keywords

LPN/LVN OR RN LicenseUtilization Review ExperienceClinical ExperiencePrior AuthorizationsManaged Care Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentPrecertification ReviewMedical Policy ComplianceTreatment Setting ReviewBenefit Plan Analysis

Industry Keywords

Healthcare IndustryMedicaidMedicareMulti-State LicensureMedical Necessity Determination

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.
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.
Does not issue medical necessity non-certifications.

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.
Understanding of managed care or Medicaid/Medicare is preferred.
Previous experience in healthcare industry is strongly preferred.
Previous experience working with prior authorizations is highly preferred.

Benefits

Comp & perks

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